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18-001 Twisters Gymnastics CITY OF
No.
FY2018-19
CUPERTINO
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made and entered into as of 9/7/2018 ("Effective Date"),by and
between the City of Cupertino, a municipal corporation("City"),and with TWISTERS GYMNASTICS,
("Contractor"), a CORPORATION for
GYMNASTICS CAMPS.AND CLASSES.
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 6/30/2019 (.,Contract i
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.
4. Compensation. Ci tywill pay Contractor for satisfactory performance of the
Services an
amount that will based upon actual costs but that will be capped so as not to exceed$150,000("Contract
Price"),based upon the Scope of Services,budget,performance schedule, and rates included in Exhibit
A. The maximum compensation includes all costs, expenses and reimbursements and will remain in
place even if Contractor's actual costs exceed the capped amount.Contractor must submit invoices and
the information required in Exhibit A in order to receive payment. City will compensate Contractor
within 30 days after approval of written invoices.
Invoices are subject to review and audit by City during regular business hours upon 24-hours'
notice. Contractor must 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 final payment.
5. Independent Contractor.Contractor is an independent Contractor and not an employee, '
partner, or joint venture of City. Contractor is solely responsible for the means and methods of
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. 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.
Recreation Services Agreement/Rev. 3-27-2018
Page 1 of 6
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
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 constitute City property.
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 years from the date of City's
final payment.
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 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 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.
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
Recreation Services Agreement/Rev.3-27-2018
Page 2 of 6
discretion may purchase insurance and deduct the costs from payments to Contractor, or terminate the
contract.
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 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 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 fingerprinting and a criminal background check and verify all employees
providing services under this contract have met this requirement.
B. Complete a Tuberculosis screening test as required by law and as set forth 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,AB2007, and other laws pertaining to concussion evaluation, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
https://www.cdc.gov/headsul2/index.htmD.
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 Recreation&Community Services Instructor Manual.
Recreation Services Agreement/Rev.3-27-2018
Page 3 of 6
Check one (if applicable):
® This contract requires services for children.
❑ This contract currently does not require services for children. If in the future, services
for children are required,the contract will require a'written amendment' to include the
appropriate insurance coverages as required in'Exhibit B-Insurance Requirements for
Recreation Contracts', proof of finger printing and additional requirements under
Paragraph 13. The contract amendment will also require the approval of the Director of
Recreation and Community Services and City Attorney.
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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:Jeff Ordway Name: Vincent Fusilero
Position: Recreation Coordinator Position: Owner
Contact:jeffo@cul2ertino.org;408-777-3327 Contact:
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.
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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.
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18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will
be entitled to reasonable attorney fees and costs. This Section survives this Agreement.
19. Third Party Beneficiaries. There are no third party beneficiaries under this Contract.
Recreation Services Agreement/Rev.3-27-2018
Page 4 of 6
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 of 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 the main contract and any attachments or exhibits
thereto,the main contract shall prevail.
22. Inserted Provisions. Each provision or clause required by law or this contract is deemed
to be included and will be inferred herein. Either party may request an amendment to cure any
mistaken insertion or 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
date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the
United States Mail, postage prepaid, registered or certified, or the next business day following
electronic submission.
To City of Cupertino: To Contractor:
Office of the City Manager
10300 Torre Ave.,Cupertino CA 95014 cc: Representative/Coordinator:
cc:Representative/Coordinator: Vincent Fusilero
Jeff Ordway Email:
Email: ieffo@cupertino.org
I�
Recreation Services Agreement/Rev. 3-27-2018
Page 5 of 6
27. Validity of Contract.This contract is valid and enforceable only if it complies with the
provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or
authorized designee, and is approved for form by the City Attorney's Office.
28. Execution. 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.
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IN WITNESS WHEREOF, the parties have caused this contract to be executed.
1
CONTRACTOR CITY OF CUPERTINO
TWISTERS GYMNASTICS A Municipal Corporation
I
By By
Name t��c� �Oc� �LC Name I'1��`k�s J _;;7-W1
Title C +� �� Title b
Date C48I 1 Date
Tax I.D. No.:Refer to W9
APPROVED AS TO FORM:_ ATTEST:
-OCIO V. FIERRO GRACE SCHNIIDT
Cupertino Acting City Attorney City Clerk 0 l o
Fiscal Year 2018-19
ContractlEncumbered Amount:$150,000
Account No.:580-63-620 700-702
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Recreation Services Agreement/Rev. 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide GYMNASTICS CAMPS AND CLASSES in,but not limited to,
the following:
PRESCHOOL 1: LEAPING LIONS,PRESCHOOL 2:JUMPING GIRAFFES,PRESCHOOL 3:
CARTWHEEL KANGAROOS,PRESCHOOL 4:BOUNCING BEARS, RECREATIONAL
GYMNASTICS LEVEL 1,RECREATIONAL GYMNASTICS LEVEL 2,RECREATIONAL
GYMNASTICS LEVEL 3,RECREATIONAL GYMNASTICS LEVEL 4,PRIVATE GYMNASTICS
LESSONS, GYMNASTICS CAMP, GYMNASTICS PRESCHOOL CAMP, GYMNASTICS AND
DANCE COMBO CAMP GYMNASTICS AND TAEKWONDO COMBO CAMP
Location and Time of CONTRACTOR Services:
Refer to the Recreation Schedule dated SUMMER 2018; THROUGH SPRING 2019 for agreed upon
dates, times, and class locations. The City, at its sole discretion,may change the agreed terms.
Compensation for CONTRACTOR Services:
Contractor shall be compensated for services performed pursuant to this Agreement. Compensation
shall consist of the following: 64% OF THE RESIDENT REGISTRATION FEE. The total compensation
to the Contractor shall not exceed $150,000.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
Minimum: VARIES(1-2)
Maximum: VARIES (6-8)
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.
List of all Contractor Employees working for the City of Cupertino (if no Employees, identify
"self"):
©�ar�Grl N��cc�n
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Performance of CONTRACTOR Services:
In the case Contractor unilaterally cancels performance of a class, camp, activity or service without
City approval, City reserves the right to immediately and without notice cancel the remainder of
programs/services offered and or performed by Contractor.
The Contractor shall follow all guidelines pertaining to registration procedures as listed in the
quarterly recreation schedule.Participants may not 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 of legal guardian has
arrived and all minors are released to them.
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.
Exhibit B
Insurance Requirements for Recreation Contracts
As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance
for the duration of the contract against claims arising from or in connection with Contractor, its agents,
representatives, employees or subcontractors Services under this Agreement.
Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as:
1. Commercial General Liability(CGL): Insurance Services Office Form CG 00 01 covering CGL on an
"occurrence" basis, including property damage, bodily injury and personal & advertising injury with
limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply
separately to this project/location(CG 25 03 or 25 04)or be twice the required occurrence limit.
2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), or if Contractor has no owned autos,
Code 8 (hired) and 9(non-owned), with limits no less than $1,000,000 per accident for bodily injury and
property damage.
❑ Required if automobile is used to perform work-tinder this contract.
Otherwise, proof of Contractor's personal auto insurance i'vith limits required by state law
st ffices. Contractor shall not transport or use its personal vehicle to transport participants or
perforin work under this contract.
3. Workers' Compensation: As required by the State of California, with Statutory and Employer's
Liability Insurance lunits of no less than$1,000,000 per accident for bodily injury or disease.
Required if Contractor has employees.
❑ If no employees, Contractor must sign Affidavit of No Employees.
4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving
minors, (i.e., after school activities, recreational programs, athletics, study/training events and
transportation of minors). Coverage may be included under General Liability or be obtained in a separate
policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per
occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the
required occurrence limit.
I Required if Contract involves services to children.
Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance.
Self-Insured Retentions: Self-insured retentions must be approved by City. City may require Contractor to
provide proof of ability to pay losses and related investigations, claim administration, and defense
expenses within the retention. The policy language must provide, or be endorsed to provide, that the self-
insured retention may be satisfied by either the named insured or City.
Acceptability of Insurers:Insurance must be issued by insurers acceptable to City and licensed to do business
in the State of California,with an A.M. Best's financial strength rating of"A" or better and a financial size
rating of"VII" or better.
OTHER INSURANCE PROVISIONS: The CGL policy must contain, or be endorsed to contain, the
following provisions:
1. The City, its City Council, boards and commissions, officers, officials, employees, agents, servants
and volunteers are to be covered as additional insureds with respect to liability arising out of work or
Ech. B Insurance,for Recreation Contracts Updated 3-26-18
1
operations performed by or on behalf of the Contractor including materials, parts or equipment
furnished in connection with such work or operations.
2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 01 04
13 as respects the City, its officers, officials, employees,agents, and volunteers.
3. The Insurance Company agrees to waive all rights of subrogation against the City, its elected or
appointed officers, officials, agents,and employees for losses paid under the ternls of any policy
which arise from work performed by Contractor for City. This provision also applies to the
Contractor's Workers' Compensation policy.
4. Each insurance policy required by this contract shall provide that coverage shall not be canceled,
except with notice to the City.
Primary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non-
contributory and at least as broad as ISO CG 20 01 04 13 as respects the City and all the
insureds/indemnitees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance,
the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall
also apply on a "primary and non-contributory"basis for the benefit of the Additional Insureds before City's
own insurance is triggered.
Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to
expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of
premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager.
Waiver of'Subrogation: Contractor grants City a waiver of any right to subrogation which any insurer of said
Contractor may acquire against City by virtue of payment of any loss under such insurance. Contractor will
obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies
regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer.
Verification of Coverage: Contractor shall furnish the City with original certificates and amendatory
endorsements effecting coverage required by this clause. All certificates and endorsements are to be received
and approved by the City before work commences. The City reserves the right to require complete, certified
copies of all required insurance policies, including endorsements affecting the coverage required by these
specifications, at any time. At a minimum Contractor must provide acceptable copies of the policy
declarations and endorsement page verifying the required insurance coverages.
Homeowner's Insurance: Contractor's homeowner's liability insurance may provide coverage sufficient to
meet these requirements. Contractor should provide these requirements to his or her agent to confirm and
provide verification to City.
Special Events Coverage:Insurers may provide special events coverage for a reduced fee, or City may be
able to offer this coverage. Contractor should contact the City Manager's Office for information or assistance.
Special Risks or Circumstances: City reserves the right to modify these requirements based on the nature of
the risk,prior experience, insurer, coverage,or other special circumstances.
Esh. B Insitrance for Recreation Contracts Updated 3-26-18
2
EXHIBIT D
Contractor's Mandated Reporter Declaration
The undersigned does hereby certify that:
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1. I am a representative of TWISTERS GYMNASTICS; that I am familiar with the facts
herein and am authorized and qualified to execute this declaration.
2. I declare that TWISTERS GYMNASTICS 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"):
a c)a�k(bn c�
a
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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.
TWISTERS GYM ASTICS
By \
Name VJ
Title 2(— `,
Date CO� I ,A 11�
AC R TWIST20 OP ID: KE
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
06/29/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 CONTACT
Snyder Insurance Services Inc NAME: Snyder Insurance Services, Inc
7450 W. 130th Street-Ste 230 PHONE
Overland Park, KS 66213 _A/c No EXt:800-874-6704 FAX No: 913-498-0212
EMAIL
House ADDRESS:nicole@insureasset.com
INSURERS)AFFORDING COVERAGE NAIC q
INSURED Twisters Gymnastics, Inc INSURER A:New Hampshire Insurance Co 23841
dba Twisters Sports INSURER B:Mutual of Omaha
INSURER D:Evanston Insurance Company
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN_SR ADDL SUBR
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP
MMIDD/YYYY MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE X OCCUR Y Y 44241282-03 11/14/2017 11/14/2018 DAMAGE 0 REN ED
PREMISES Ea occurrence $ 300,000
X IncludesParticip MEDEXP(Anyoneperson) $ Excluded
$
GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY 2,000,000
X POLICY❑ PRO--JECT LOC GENERAL AGGREGATE $ 3,000,000
PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER. Abuse/Mol $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
C Eaaccidenl $ 1,000,000
ANYAUTO 04467447-7 11/20/2017 11/20/2018 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) S
HIRED AUTOS NON-OWNED
AUTOS PROPERTY DAMAGE $
Per accident
X UMBRELLA LIAR OCCUR
EACH OCCURRENCE $ 1,000,000
D X EXCESS LIAR CLAIMS-MADE XOBW7716918
06/28/2018 11/14/2018 AGGREGATE $ 1,000,000
DED RETENTION$
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY PER OTH-
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE ER
OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $
(Mandatory in NH)
If yes,describe under E.L.DISEASE-EA EMPLOYEE S
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $
B Participant Excess SR2014CA-P-102000-A27 11/14/2017 11/14/2018 Per.Ace.
B Catastrophic Med 100,000
SB21CCCA-P-106000-A27 11/14/2017 11/14/2018 10yr.Bnf 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
The City of Cupertino, its City Council, boards and commissions, officers,
officials, employees,agents,servants,and volunteers are listed as
Additional Insured and waived from subrogation under the liability policy
per operations of the Named Insured.
CERTIFICATE HOLDER CANCELLATION
CUPER-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Cupertino, Its Council ACCORDANCE WITH THE POLICY PROVISIONS.
,Boards&Commissions,
Officers,Employees,&Volunteers AUTHORIZED REPRESENTATIVE
10300 Torre Ave
Cu ertino CA 95014 / 1988-2014 ACORD ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
ENDORSEMENT NO#3
This endorsement, effective 12:01 A.M. 06/25/2018
Forms part of Dolicv no.:44241282-03
issued to:Twister's Gymnastics, Inc
DIB/A:Twister's Gymnastics, Inc
By: NEIN HAMPSHIRE INSURANCE COMPANY
IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF$ 101.00, IT IS HEREBY U14DERSTOOD AND AGREED
THAT the following is added to the policy as a Waiver of Subrogation:
City of Cupertino, Its City Council, Boards and Commissions, Officers, Officials, Employees, Agents,
Servants, Volunteers and Consultants, 10300 Torre Ave, Cupertino, CA 95014
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS OF THIS POLICY REMAIN UNCHANGED.
Authorized Representative or
Countersignature (in states where Applicable)
POLICY NUMBER:44241282-03 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROIDUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Narne Of Person Or Organization:
City of Cupertino,Its City Council,Boards and Commissions,Officers, Officials, Employees,Agents,
Servants,Volunteers and Consultants, 10300 Torre Ave,Cupertino, CA 95014
Information required to complete this Schedule if not shown above will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV—Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments mie make for injury or
damage arising out of your ongoing operations or`your
work" done under a contract with that person or
organization and included in the "products-completed
operations hazard". This waiver applies only to the
person or organization shown in the Schedule above_
CG 24 04 06 09 Insurance Services Office, Inc., 2008 Page 1 of 1
ENDORSEMENT#2
This endorsement, effective 06/25/2018 at 12:01 AM
Forms apart of policy no.: 44241282-03
Issued to: TWISTER'S GYMNASTICS INC
D/B/A:TWISTER'S GYMNASTICS INC
By: New Hampshire Insurance Company
IN CONSIDERATION OF THE PREMIUM CHARGED IT IS HEREBY UNDERSTOOD AND AGREED THAT
the Additional insured Required by Written Contract endorsement is added to the policy as follows:
City of Cupertino, Its City Council,Boards and Commissions, Officers, Officials, Employees,
Agents, Servants,Volunteers and Consultants, 10500 Torre Ave, Cupertino, CA 95014
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS THIS POLICY REMAIN UNCHANGED,
Authorized Representative or Countersignature
ENDORSEMEN"r
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
This endorsement, effective 12:01 a.m. 06/25/2018 forms a part of Policy
No.44241252 -03 issued to TWISTER'S GYMNASTICS INC d/b/a TWISTER'S GYMNASTICS INC
by New Hampshire Insurance Company
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY POLICY, COVERAGE APPLICABLE TO COVERAGE A. BODILY INJURY AND
PROPERTY DAMAGE(SECTION I - COVERAGES)ONLY
A. Section II - Who Is An Insured is amended to ii. Supervisory,inspection, architectural, or
include any person or organization you are engineering activities.
required to include as an additional insured on 5. This insurance does not apply to "bodily
this policy by a written contract or written injury" or "property damage" arising out of
agreement in effect during this policy period and "your work"or "your product" included in the
executed prior to the "occurrence" of the "bodily "product-completed operations hazard"
injury" or"property damage." unless you are required to provide Such
B. The insurance provided to the above described coverage by written contract or written
additional insured under this endorsement is agreement and then -only for the period of
limited as follows: tirne required by the written contract or
9. COVERAGE A BODILY INJURY AND PROPERTY ,,mitten agreement and in no event beyond
DAMAGE (Section I - Coverages) only. the expiration date of the policy.
2. The person or organization is only an b. Any coverage provided by this endorsement to
additional insured with respect to liability an additional insured shall be excess over any
arising out of"your work" or "your product". other valid and collectible insurance available
to the additional insured whether primary,
3. In the event that the Limits of insurance excess, contingent or on any other basis.
provided by this policy exceed the Limits of C. In accordance with the terms and conditions of
Insurance required by the written contract or the policy and as more fully explained in the
written agreement, the insurance provided by otic as soon asmore
fully
each additional
this endorsement shall be limited to the policy practicable,
Limits of Insurance required by the written insured must give us prompt notice of any
contract or written agreement subject to the "occurrence" which may result in a claim,
policy aggregate. This endorsement shall not forward all legal papers to us, cooperate in the
increase the Limits of Insurance shown in the defense of any actions, and otherwise comply
Declarations pertaining to the coverage with all of the policy's terms and conditions.
provided herein. Failure to comply with this provision may, at out,
option, result in the claim or"suit" being denied.
4. The insurance provided to such an additional
insured does not apply to bodily injuryor All other terms and conditions of the policy remain
"property damage" arising out of an the same.
architect's, engineer's, or surveyor's
rendering of or failure to render any
professional services, including, but not
limited to:
i. The preparing, approving, or failing to
prepare or approve maps, shop drawings, Authorized Signature
opinions, reports, surveys, field orders,
change orders, or drawings and
specifications; and
100454(3/09) Page 1 of 1
Includes copyrighted information of the Insurance Services Offices, Inc., with its permisssion.
All rights reserved.
A`� CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
8/24/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have 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 CONTACT
NAME:
EMPLOYERS CHOICE INS SVCS INC PHONE
A/C N E 760 431-0947 FAX No: 760 687-4007
2111 S EI Camino Real#201 ADDRIEss: aflo d wkcom .net
Oceanside, CA 92054 INSURER$ AFFORDING COVERAGE NAIC M
INSURED INSURER A: State Compensation Insurance Fund
Twister's Gymnastics INSURER B:
INSURER C:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICYEFF POLICYEXP
LTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS
COMMERCIAL GENERAL LIABILITY
CH OCCURRENCE $
CLAIMS-MADE EIOCCUR RENTED PREM GES nce $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑PRO-
JECT ❑LOC
PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO
OWNED SCHEDULED BODILY INJURY(Per person) $
AUTOS ONLY AUTOS BODILY INJURY(Peraccident) $
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $
Per accident
UMBRELLA LIAB OCCUR
EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION$
WORKERS COMPENSATION v $
AND EMPLOYERS'LIABILITY Y/N /� STATUTE ERH
ANY PROPRIETOR/PARTNER/EXECUTIVE
A OFFICER/MEMBER EXCLUDED? L N/A 9237106-2018 8/25/2018 8/25/2019 E.L.EACH ACCIDENT $ 1,000,000
If yes,describe under(Mandatory in E.L.DISEASE-EA EMPLOYE $ 1,000,000
nd
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS CERTIFICATE IS PROVIDED
AS PROOF OF INSURANCE. AUTHORIZED REPRESENTATIVE
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
SNYDER INS AGENCY PR`99RFIl/UE°
7450 W 130TH#230 COIWWRC/AL
OVERLAND PARK,KS 66213
Named insured Policy number:
Underwritten by:
United Financial Cas Co
May 8,2018
TWISTERS GYMNASTICS Policy Period:Nov 20,2017-Nov 20,2018
prog ressiveagent.com
Online Service
Make payments,check billing activity,print
policy documents,or check the status of a
Commercial Auto m.
1-80ai6704
Insurance Coverage Summary SNYDER INS AGENCY
Contact your agent for personalized service.
This is your Declarations Page 1-800-444-4487
Your coverage has changed For customer service if your agent is
unavailable or to report a claim.
Your coverage began on November 20,2017 at 12:01 a.m. This policy expires on November 20,2018 at 12:01 a.m.
This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your
coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto, unless the
policy contract allows the stacking of limits.The policy contract is form 6912(06/10).The contract is modified by forms 4757(03/05),
MC1632 (06/04),4852CA (10/04),4881CA (12/04)and Z228(01/11).
The named insured organization type is a corporation.
Policy changes effective May 4,2018
.............................................................................................................................................................................
Premium change: $0.00
.............................................................................................................................................................................
Changes: The driver information has changed.
The changes shown above will not be effective prior to the time the changes were requested.
Outline of coverage
Description Limits Deductible Premium
.............................................................................................................................................................................
Liability To Others $5,951
Bodily Injury and Property Damage Liability $1,000,000 combined single limit
.............................................................................................................................................................................
Uninsured/Underinsured Motorist Rejected
.............................................................................................................................................................................
Uninsured Motorist Property Damage Rejected
.............................................................................................................................................................................
Medical Payments $5,000 each person 222
...............................................................................................................................................I.............................
Comprehensive 218
See Auto Coverage Schedule Limit of liability less deductible
.............................................................................................................................................................................
Collision 671
See Auto Coverage Schedule Limit of liability less deductible
Subtotal policy premium $7,062.00
.............................................................................................................................................................................
California Vehicle Assessment Fee 7.04
.............................................................................................................................................................................
Total 12 month policy premium and fees $7,069.04
continued
Form 6489 CA(06/10)
Policy number: 04467447-8
TWISTERS GYMNASTICS
Page 2 of 3
Important information about fees
You have paid installment fees of$24.00 on this policy.An additional installment fee of$6.00 has been included in each
remaining payment.You may reduce the amount you pay in installmentfees by paying your premium in larger amounts
and fewer installments. Please call your agent for details.
The following additional fees may apply:
Late payment fee $10.00
Fee for returned checks or refused payments$20,00
Rated drivers
.......................................................................................................................................................................
1,
Auto coverage schedule
1.
Garaging Zip Code: 94089 Radius: 50
Liability Liability Med Pay
.....................................................................................................................................
Premium $1,413 $60
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium Auto Total
Premium $1,000 $58 $1,000 $150 $1,681
2.
Garaging Zip Code: 94089 Radius: 50
Liability Liability Med Pay ....................................
..........
......................................................................................... ....
Premium $1,314 $55
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium Auto Total
Premium
$1,000 $53 $1,000 $167. $1,589
3.
Garaging Zip Code: 94089 Radius: 50
Liability Liability iability Med Pay .......................................
.. . .............. . ...................................................................................................
Premium $1.,.398. $5.3
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium ......Auto. .
Total
......................................................................................................................................... ........ .. .... ..
Premium $500 $43 $500 $149 $1,643
continued
Form 6489 CA(06/10)
Policy number: 04467447-8
TWISTERS GYMNASTICS
Page3 of 3
4.
Garaging Zip Code: 94089 Radius: 50
Liability Liability Med Pay
.....................................................................................................
Premium $1,826 $54
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium Auto Total
......................
Premium $500 $64................................................................................................................................... . .. . .
$500 $205 $2,749
*A vehicle's stated amount should indicate its current retail value,including any special or permanently attached equipment. In the
event of a total loss,the maximum amount payable is the lesser of the Stated Amount or Actual Cash Value, less deductible. Be sure
to check stated amount at every renewal in order to receive the best value from your Progressive Commercial Auto policy.
Premium discounts
Policy
.............................................................................................................................................................................
Business Experience and Package
Loss Payee information
....................................................................................................................................................................
1 . Loss Payee Auto 1 GMAC
PO BOX 674 MINNEAPOLIS, MN 55440
2007 Chevrolet Express G3500(1 GAHG39UX71245729)
....................................................................................................................................................................
2 . Loss Payee Auto 2 MECHANICS BANK
725 ALFRED NOBEL DR HERCULES, CA 94547
2004 Ford Econoline E350(1 FDSS31 L94HB01134)
Company officers
President Secretary
Form 6489 CA(06/10)
