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25-001 Lisa Molaro DBA MudnStix for Ceramics and Art Instruction
CITY OF CUPERTINO RECREATION SERVICES AGREEMENT No. FY2026 - 2031 1. Parties. This contract is made by and between the City of Cupertino, a municipal corporation ("City'), and Lisa Molaro DBA MudnStix ("Contractor"), a Sole Proprietorship/Individual for Ceramics and Art Instruction and is effective on 09/01/2025 ("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 08/31/2030 ("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 $1,025,000.00 ("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 requires services for children. 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: Robert Kaufman Name: Lisa Molaro Position: Recreation Coordinator 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. 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. Recreation Services Agreement/ Rev. April 2025 Page 4 of 7 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. 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 Recreation Services Agreement/ Rev. April 2025 Page 5 of 7 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: To Contractor: Lisa Molaro DBA MudnStix Office of the City Manager Email: robertk@cupertino.gov 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 By ¢ti Name Tina Kapoor Title Interim City Manager Date Sep 17, 2025 APPROVED AS TO FORM: 7,a e uJaa MICHAEL K. WOO Senior Assistant City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Sep 17, 2025 CONTRACTOR By Name Lisa Molaro Title Ceramics Instructor Contractor Date Sep 17, 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 Ceramics and Art Instruction in, but not limited to, the following: Ceramic and Art Camps for Youth and Teens Primary and/or contractors will provide half and full day camps for youth and teens, pertaining to a variety of art mediums and ceramic disciplines. Youth and Teen Ceramic Classes • Primary and/or contractors will provide ceramic courses for youth aged 2-17 and ceramic courses hand building and potter's wheel for teens. Adult Ceramic Classes • Primary and/or contractors will provide adult courses for hand building, and beginner, intermediate, and advanced pottery wheel classes for adults. Open Ceramic Studio • Primary and/or contractors will provide a supervised Open Ceramic Studio, participants will be free to utilize the studio for personal projects at their own pace. The contractor provides a community gathering service along with supervision to ensure the safety of the participants, equipment, and facility. Private Lessons Primary and/or contractors will provide Private Lessons for one or two individuals, instructing them on ceramic concepts at a pace suitable for them. Private Ceramic and Art Parties Primary and/or contractors will provide private birthday, corporate, and other parties for up to 30 individuals. Neighbors can enjoy an interactive party while using the park space of Wilson Park. Parties will be 2 hours, where attendees can participate in ceramics together. The contractor will allow participants to decorate, and contractor will provide additional tables for food and participants are included in the experience. 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. Updated 04129125 Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. For a class taught in person, classes, camps, workshops, private Lessons: 60% of the resident fee based on final rosters. Birthday parties, open studio, corporate events: 70% of total fees collected. 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: 3 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. 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 (ii) 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. Contactor 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. 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). I xh. B Insurancefir it Recreation Contracts updated May 2025 VIn 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. F If 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. F Not 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 (11185) 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 I xh. B Insurancefir it Recreation Contracts updated May 2025 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 10"). 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. 8 Insurance f tr Recreation Contracts updated May 2025 3 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 6387-39451646096049 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Cupertino Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Lisa Molaro TYPE: Arts And Crafts (Various) LOCATION: Wil-n Park Ceramic Cenier, f97M winegeen NMe, Cuperlim, CA 95014 *Liquor Liability Yes o No @ "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ics) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: MKLV7PBC0o 1969 MASTER POLICY DATES: EFFECTIVE: January 01, 2025 EXPIRATION: January 01, 2026 COMMERCIAL GENERAL. LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal & Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: Medical Payments (Any One Person) 5,000 MEGL I643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,0001$3,000,000 ❑ $2,000,0001$2,000,000 Property Damage (If purchased) No Property Damage Coverage The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, Volunteers and Consultants CANCELLATION: Should the above described policy be cancelled before the expiration date thcrcof, notice will be delivered in accordance with the polio provisions, AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/31/2025 POLICY NUMBER: MKLV7PBC001969 COMMERCIAL GENERAL LIABILITY CG20260413 11:1KI4k,ISI■RRI4►►14►Igo]:►_►► lei n N9:121:1411 MII:F-E-y=1:l:r--l1111[*7_r:741IIII4Wo ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization(s): City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents, Servants, and Volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the © Insurance Services Office, Inc., 2012 Page 1 of 1 CG20260413 oil POLICY NUMBER: MKLV7PBC001969 MARKEL EVANSTON INSURANCE COMPANY FORMS SCHEDULE FORM NUMBER FORM NAME MJIL 1000 08 10 Policy Jacket/Signature Page MPIL 1007 01 20 Privacy Notice MPIL 1039-CA 01 20 California Surplus Lines Notice (D-2) MPIL 1041 02 20 How To Report A Claim MPIL 1083 04 15 U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders MDIL 1001 08 11 Forms Schedule IL 00 21 09 08 Nuclear Energy Liability Exclusion Endorsement GD MEIL 1231 10 13 Minimum Earned Premium And Minimum Retained Premium MDGL 1008 08 11 BC Commercial General Liability Coverage Part Declarations CG 00 01 04 13 Commercial General Liability Coverage Form CG 02 24 10 93 Earlier Notices of Cancellation Provided By Us CG 20 01 04 13 Primary & Noncontributory - Other Ins Condition CG 20 11 0413 Additional Insured -Managers or Lessors of Premises CG 20 26 04 13 Additional Insured - Desg Person or Organization CG 21 3311 85 Exclusion - Designated Products CG 21 47 12 07 Employment Related Practices Exclusion CG 21 58 04 13 Exclusion - Professional Veterinarian Services CG 21 7001 15 Cap on Losses From Certified Acts of Terrorism CG 21 7601 15 Exclusion Of Punitive Damages Related To A Certified Act Of Terrorism CG 21 96 03 05 Silica Or Silica -Related Dust Exclusion IL 00 17 11 98 Common Policy Conditions ESX MEGL 0241 05 16 Waiver Of Transfer of Rights Against Others to Us MEGL 1639 08 14 Excl - Aircraft and Hot Air Balloon Rides, Demos & MEGL 2300 11 19 Exclusion - Marijuana MEGL 2322 05 21 Exclusion - Communicable Disease MEGL 5300 05 16 Exclusion -Organic Pathogen And Legionellae MEGL 5302 05 16 Exclusion - Asbestos MEGL 5303 05 16 Exclusion - Lead MEIL 1200-CA 02 23 Service Of Suit - California MEIL 1225 10 11 Changes - Civil Union MEIL 1251 10 21 Two Or More Coverage Forms or Policies MGL 1319 01 16 Exclusion - Unmanned Aircraft MGL 1356 10 20 Exclusion - Cyber Incident, Data Compromise, And Violation Of Statutes Related To Personal Data MIL 1214 09 17 Trade or Economic Sanctions IL 12 01 11 85 Policy Changes - for CA MDIL 1000-CA 08 11 Common Policy Declarations MDIL 1001 08 11 Page 1 of 2 MEGL 0205 01 24 Abuse, Molestation, Or Exploitation Coverage -Defense Costs Within Limits MEGL 1638 11 19 Concert or Performance Exclusions and Limitations MEGL 1640 08 14 Exclusion - Aircraft and Watercraft Liability Assumed Under An Insured Contract MEGL 1641 05 16 Exclusion - Amusement Devices and Rides MEGL 1642 10 14 Exclusion - Boxing, Wrestling and Contact Martial Arts MEGL 164308 14 Exclusion - Entertainers, Participants and Equipment MEGL 1644 08 14 Exclusion - Fireworks, Pyrotechnics and Flashboxes MEGL 1645 08 14 Exclusion - Motorized Sporting Events MEGL 1646 08 14 Exclusion - Professional Sporting Events MEGL 1647 08 14 Exclusion - Rodeos and Roping Events MEGL 1664 08 15 Exclusion - Obstacle Course Races and Mud Runs MEGL 1851 08 14 Additional Insured - Concessionaires, Exhibitors and vendors MEGL 1852 08 14 Aggregate Limit of Insurance MEGL 1853 10 14 Broadened Insurance MEGL 1854 08 14 Damage to Property Coverage MEGL 1855 08 14 Liquor Liability Coverage MEGL 1856 10 14 Premium Reporting MEGL 1857 11 17 Primary and Noncontributing Insurance MEGL 2632 01 24 Exclusion -Abuse, Molestation, Or Exploitation MAIL 1001 08 11 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG2001 0413 ►]�iT1Ti�11,T,l�IL+I� ►�17�L�7� All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rats. If the first Named Insured cancels, the refund may be less than pro rats. The cancellation will be effective even if we have not made or offered a refund. S. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; INTERLINE IL OD 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. E. Premiums The first Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay- F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 CSAA Insurance Exchange P.O.Aox 22221 Oakland, CA 94623-2221 1. Name and Address of rnnurud Ah, emere Address Automobile Policy Declarations Please keep with your policy. See Important Notice on reverse. For questions or changes call: 000.922.8228 Page 1 of 1 Z Q D1`11 arrons type Renewal Certificate Process 10-03-2024 Dam a Policy Insured 2004 Since rVym6P+ +x � rrom 12.01 A.A6 Standard rime at [he address of the LL Named Insured, but not pnor to the time applied z for or, if this is a replacement dedafatrans, not r Your 1 Q-29-2024 prior to the tMe coverage change was rMuesred. U Policy -� 0 Penod to 12.fl l AM. standard Time at the address of addreof the a. a 10.29-2025 clamed insured- euwmare Number Engineer/Scientist (408) 323-7255 Telephone Number (65D) 906-1171 r em Make Model Yr Body Type Nehrcke ldentlhcairon No Name W 1 DONALD not 2 neressardy LISA Y correspond _U = C roprrnopaHy Benjamin LAJ operated rehrdes o0b, ty Limits Cm"rage — — — — — T Ilem i DedurriF& T — — — Premium Item 2 _ aeducr,we T �" R Prem,um Prem.um Premium �eeuchble rT — — — ^ aed'ucrEach Irma Person Each occurrence ! m r [rmrl e.rmrr Bodily Injury 500,000 500,000 1 $327 1 $215 Medical Payments $36 I $14 —10,000r------- Uninsured Motorists 500,ODD $112 I $68 i _300,000— — — Uninsured Motorist 0 NO COV NO CmV l I Property Damage _______ l Property Damage 300,000 $442 $363 I I f ^Comprehensive Actual Cash Value Less Deductible 500 I $119 500 $54 I f 1 Full Comprehensive Safety Glass Endorsement I NO COV I NO COV I l { g (So deductible) ' } II Collision Actual Cash Value Less Deductible 1,000 1,000 1 $784 $322 [+I Collision Deductible Waiver INCL INCL I ffI xEnhanced Transportation Expense $25130 I $28 $25/30 1 $28 I I �++ $ Limit per day 1 max days V II Risks Actual Cash Value Less Deductible No Coverage No Coverage l l Vehicle Loan/Lease Protection Endorsement No Co erage No Coverage New Car Added Protection Endorsement No Co erage No Co erage Original Equipment Manufacturer Parts [OEM] Endorsement No Coverage No Coverage l l Ride sharing Coverage Endorsement No Coverage No Coverage l i TOTAL PREMIUM PER VEHICLE D $1,848 $1,064 * Automobile Death Benefits $15,000 per deceased insured person ��Rr,um $g Premium Summary This is not a bill. CA Surcharge: $0 CA Special Fraud Assessment Fee: $3.52 Total Premium: $2,924,52 Total Premium shown is for the Member AdvantacieTM Program. r SION5 s no coverage provided by this Policy while the following individual(s) operate a motor vehicle: Schedule of Changes N W L � z a x u 55 1500 1215 (Continued an back) DATE (MMIDDIYYYY) ACvR" CERTIFICATE OF LIABILITY INSURANCE llh� " 06/27/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: BI$ERKO N $44-472-0967 � jC NO:203-654-3613 P.Q. Box 113247 E-MAIL Stamford, CT 06911 ADDRESS: customerservice@biBERK.com INSURERS}AFFORDING COVERAGE _ NAIC # INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSURED Lisa Molaro I NSU RER C : INSURER E INSURER F : rri 1TAI :10214 26 elA:i111IyrrLIII 111 :5,lll IT] I:iA: "IATA61rol►0kiIlIF, I:1:: 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 I ADOL-TYPEOF INSURANCE INSD SUER POLICY NUMBER MMIDDFfYY MMfDDFfY POLICYEFFT POLICY P LTR LIMITS CO MM ERCIA L G EN ERA L LIABILITY EACH OCCURRENCE $ 0 CLAIMS -MADE OCCUR DAMAGETO RENTED PREMISES Ea occurrence $ 0 MED EXP (Arty one person) $ 0 PERSONAL & ADV INJURY $ 0 $ 0 GEN'L AGGREGATE UMlT APPLIES PER: GENERALAGGREGATE POLICY PRO- LOC PRODUCTS - COMPIOP AGG $ 0 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE rp.,aceiden $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE❑ I RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFI CE RIM E M BER EXCLUDED? (Mandatory in NH) N f A x N9WC245710 fl4,rd1�Z025 04�a1�2025 x PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L.DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,000 E.L. DISEASE - POLICY LIMIT Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATI0N51 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy #N9WC24571 0 contains a blanket Waiver of Subrogation therefore the insurer agrees to waive its right to recover from the certificate holder to the extent required by written contract. Additional Named Insured:Mudnstix Notice of Cancellation provided per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 Torre Ave Cupertino, CA 95014 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 REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be i_ao % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Policy No. N9WC245710 Insurance Company Countersigned By Endorsement No. rYl998 by the Workers' Compensation Insurance Rating 8ureau of California. All rights reserved. LV1161:1.[ 4 -14MII6] T T Wi RT-W roI► I1 i FIX41iT1 Ile] [;f .14R 1_1-14 r ird fk I&'31] _.? 1► CK:I 167 R IK7 WC 04 00 04 (Ed. 7-98) Schedule of Forms ITEM 3❑ POLICY NO. N9WC245710 Form Numbers * PN049901I - CA YOUR RIGHT TO RATING AND DIVDEND INF❑ All * PN049902B - CA POLICYHOLDER NOTICE - WC RATING LAWS All * PN049904 - CA INS. GUARANTEE ASSOC.(CIGA) SURCHARGE All * WC000000C - STANDARD POLICY All WC000001A - INFORMATION PAGE All WC000422C - TERR RISK INS PROG REAUTHORIZATION ACT All * WC040002 - CA EXT OF INFO PAGE-SCH OF NAMED INSURED All * WC040004 - CA EXT OF INFO PAGE -SCHEDULE OF FORMS All * WC040301D - POLICY AMENDATORY ENDORSEMENT-CALIFORNIA All WC040306 - CA WAIVER OF RIGHT TO RECOVER FROM OTHRS All * WC040310 - CA DUTY TO DEFEND All WC040410A - CA ESTIMATED ANNUAL PREMIUM ENDORSEMENT All * WC040422 - CALIFORNIA SHORT -RATE CANCELLATION END'T All * WC040601B - CA CANCELLATION ENDORSEMENT All * WC990000 - AUTHORIZATION AND ATTESTATION END'T All * WC990014 - CALIFORNIA CHANGES - AMENDATORY END'T All Applicable States * As part of our ongoing commitment to environmental responsibility throughout our operations, we have chosen not to reprint those forms (marked with an asterisk) that have not changed and were previously sent to you. You can obtain a new copy of any of these forms by contacting us via phone at 844-472-0967; our Customer Service Representatives will either be able to help you locate a document yourself or can send a copy to your. As always, we thank you for selecting us as your insurer. We look forward to serving you! INTERNAL USE WR Page - 3 - Information Page MGA : N9WC245710 WC 000001A Date :03/31/2025 Issuing Office: 166 First Stamford Place, PO Box 113247, Stamford, CT 06911-3247 ■ www.biDERK.com Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission WORKERS COMPENSATION AND EPA PLOYE[i5 LIABILITY INSUFZANCE POLICY rr4'C 94 GE 01 0 (ErP. Eli-2F� CALIPURNIA CANCELATIDN ENI3DR5EMENT This endois rite St ap.piias ordy to Me ilsuranre pitvrrJed by U,e policy bA"Use California is shovefl it) ttAM 31-k of the Inkrwallon Page. The carwm[aUon condition in Part Slx (Conditions) of the policy is replaced by these condlticrrs: Canaelatilon: 1_ You may tantel this polity. You must may &r d0Itier adrarit34 Well ten notte to u5 statirlg when the carlfia[aUon is to take affect 2_ We may cancel thia.polity for on@ or mire of tha llblkming reastm-. a. Nan-payrrant of pirenliurr7� b. Failur* tc report payroll; c. Failure to permit us to audit payroll as taq.uired by the terms of this pbtity or of a previous policy issued ivy us.. d. Failure to pay any additional pram. iurn rasa IJng from arr audit of payroll raquirad by Me [arme of Mi, i polwy or any preWOUS poky issued by ug; e. Mate riA mi kw"rwA ntatfon marls by you or pw ags,rk f. Falll,m to toopera ta with us In lhg .irwesbganon of a nMIm: g. Material larIure to Comply with Ifadera I or state safety ordain of wvriMen ret411inwdafiM of attr d&d0fiaMd toes C-MIMI reprasentaCrves; h. The octuirrenca of a mratoreal change in The ownership of your Lusrna55; i. The ortuirrerrea of any nhange in your twWass ar 6per6atlorm that rratenallyr inc reAA3 the hazard for Ire qua nt+ or severity of loss. j.. The occurfronca of any change in yow tsus;rsass w operation (hat requires additional or difiar9nI dassiTcabur, be :premium niculatlon. k. The accurrenta of any change in yousr tvusin ass ix operation which ccrttemplate s an activlly excluded bW our reinsurance treaties- :I.- I I ws tanrel your pr lity for any of the he mm & Itsmd in raj through (f)= wa wIU girw you 10 dabs aWvan re written ratite, slating when the cancelatian Is to taka effect. Matllmg that notica to you at your mailing address shown In Item 1 of the. Information Page will be suffitlet116 prove notice. II wa cantal ydur palltjr for any of the raAMnA 69Md in peons Ig) lhrau jh (k). we wll:l give you 30 days advance wntlen notim: however. we agree that Jn the event of tancelation and retssuance of a policy effective upon a material change in ownership or opesations, rrtrlite -Ml not to proofed. 4. II wa rrraiI the notice to you, the slated pendds of n6l.te and your right Tb eerlraAdy M tonditrdn wvtII t1A axtandad by 5 days if the place of mailing and your mailing address Is within California, 10 days If the place of mailing or your mailing address Is oLiMe of CAIjIcrnia arrd 213 days I the place of waiIing cr yeur rnaIII ng address is outs rdr} of the tJni W Mates. 5. the pelw',y parted wil l and an the day and hdur Slated in the carmelatian naUca. Tars erslarseniew G ages the policy tv whreh rt rs attached and issffechve an the date issued unless otherwise stated. (The Informatlfln below rs required only when this Eindammerd is Isaaed subaequenl to praparatlan of ttra policy.j Endorseme rn E1s&,,ve Policy No. NgWC245710 Endorsement No. Insured Insu rams Company CounLersigned By (E.d. 01-W) Declarations NOTICE: THIS POLICY IS A CLAIMS MADE AND REPORTED POLICY AND APPLIES ONLY TO CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD AND REPORTED IN WRITING TO THE INSURANCE COMPANY IN ACCORDANCE WITH THE TERMS OF THIS POLICY. AMOUNTS INCURRED AS DEFENSE COSTS WILL REDUCE AND MAY EXHAUST THE LIMIT OF LIABILITY AND ARE SUBJECT TO THE RETENTION. PLEASE REVIEW THE COVERAGE PROVIDED UNDER THIS POLICY CAREFULLY AND DISCUSS WITH YOUR INSURANCE AGENT OR BROKER. These Declarations along with the application, and the Policy with endorsements shall constitute the contract between the insured and the insurance company. Policy Number: MR254153 Unique Market Reference: B0572MR254153 Renewal of: MR244153 Named Insured: Name: City of Cupertino - Parks and Recreation Department, Public Works Department Address: 10300 Torre Avenue, Cupertino, CA 95014 Policy Period: From: 1st July 2025 To: 1st July 2026 Both days at 12:01 a.m. Local Time at the Address specified above Limit of Liability: a) USD 5,000,000 in the aggregate during the policy period for all claims brought by or on behalf of each victim, and b) USD 5,000,000 in the aggregate during the policy period for all claims brought by or on behalf of all victims and separately: c) USD 75,000 in the aggregate during the policy period for all safeguard costs resulting from all circumstances Such Limit of Liability shall be in addition to the overall Limit of Liability stated in a) and b) above. Retention: USD 35,000 each Victim Optional Extension Period: Premium: 12 months Additional premium of 100% of the annual premium plus applicable taxes, provided no claims and/or circumstances have been reported to the insurance company. In the event any claims and/or circumstances have been reported to the insurance company, the additional premium for the 12 month optional extension period will be determined by the insurance company at the time this Policy is not renewed or replaced by the insurance company USD 45,000 (annual) plus applicable taxes Notification pursuant to Clause IX. Shall be given to: Beazley Group Attn: Claims Group 65 Memorial Road, Suite 320, West Hartford Connecticut 06107, United States of America. claims@beazley.com or Other Notices: To report a circumstance under the Safeguard Additional Coverage, Call +1 844 285 4700 where a service representative will be available 24 hours a day, seven days a week Retroactive Date: 1 st July 2018 Pending or Prior Litigation Date: 1 St July 2018 Service of Suit: Service of process in any suit shall be made upon: Lloyd's America, Inc. Attention: Legal Department 280 Park Avenue, East Tower, 25th Floor New York, NY 10017 Governing Law. New York This contract is subject to US state surplus lines requirements. It is the responsibility of the surplus lines broker to affix a surplus lines notice to the contract document before it is provided to the insured. In the event that the surplus lines notice is not affixed to the contract document the insured should contact the surplus lines broker. Dated in London: 14" July 2025 fmma 6" Authorised Signature Tysers (Correspondent) EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of Lisa Molaro DBA MudnStix; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that Lisa Molaro DBA MudnStix has complied with fingerprinting and criminal background investigation requirements with respect to all Contractor's employees who may have contact with minors in the course of providing services pursuant to the Agreement, and the California Department of Justice has determined that none of those employees has been convicted of a felony, as that term is defined in California Penal Code Section 11105.3. 3. I declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once, either online or in person, before supervising a participant, as required by California Health and Safety Code Section 124235, et seq. 4. On a yearly basis, all participants shall be required to sign and return a concussion and head injury information sheet in compliance with California Health and Safety Code Section 124235, which may be in the form attached as D-1. 5. That a complete and accurate list of Contractor's employees, who may come in contact with minors during the course and scope of the Agreement, are included below. 6. All of the below mentioned employees have tested negative for TB, or X-ray results for TB, and have current documentation on file with Contractor. 7. All of the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws of this state and are willing and able to comply. List of all Contractor Employees working for the City (if no Employees, identify "self'): See attached list of employees. 8. The Contractor will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino. I declare under penalty of perjury that the foregoing is true and correct. CONTRACTOR By Name Lisa Molaro Title Ceramics Instructor Contractor , Sep 17, 2025 Updated 6123121 Ceramics and Art Instruction Final Audit Report 2025-09-17 Created: 2025-09-15 By: Webmaster Admin (webmaster@cupertino.org) Status: Signed Transaction ID: CBJCHBCAABAAu9oiQuJWOFBUOX8LfkMCdpFaCWm1O199 "Ceramics and Art Instruction" History Document created by Webmaster Admin (webmaster@cupertino.org) 2025-09-15 - 2:26:27 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2025-09-15 - 2:34:28 PM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2025-09-15 - 2:34:36 PM GMT- IP address: 54.162.222.105 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2025-09-15 - 3:22:33 PM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to Lisa Molaro ( for signature 2025-09-15 - 3:22:36 PM GMT Email viewed by Lisa Molaro ( 2025-09-15 - 4:04:02 PM GMT- IP address: 104.28.123.95 Document e-signed by Lisa Molaro ( Signature Date: 2025-09-17 - 5:45:56 PM GMT - Time Source: server- IP address: 24.130.215.60 Document emailed to Michael Woo (michaelw@cupertino.org) for signature 2025-09-17 - 5:46:00 PM GMT Email viewed by Michael Woo (michaelw@cupertino.org) 2025-09-17 - 5:46:11 PM GMT- IP address: 54.235.37.242 Document e-signed by Michael Woo (michaelw@cupertino.org) Signature Date: 2025-09-17 - 6:00:59 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Tina Kapoor (tinak@cupertino.org) for signature 2025-09-17 - 6:01:07 PM GMT Powered by Adobe CVPERTIND Acrobat Sign Email viewed by Tina Kapoor (tinak@cupertino.org) 2025-09-17 - 6:01:14 PM GMT- IP address: 18.209.174.32 Document e-signed by Tina Kapoor (tinak@cupertino.org) Signature Date: 2025-09-17 - 6:20:02 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-09-17 - 6:20:05 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-09-17 - 6:20:15 PM GMT- IP address: 54.235.37.242 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-09-17 - 6:57:40 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2025-09-17 - 6:57:40 PM GMT Powered by Adobe CVPERTINO Acrobat Sign