21-001 Amendment #1 dated 6-25-24 Sue & Kathy Line Dance Instruction1
FIRST AMENDMENT TO AGREEMENT 21-001
BETWEEN THE CITY OF CUPERTINO AND SUE AND
KATHY LINE DANCE FOR LINE DANCE
INSTRUCTION
This First Amendment to Agreement 21-001 is by and between the City of Cupertino, a
municipal corporation (hereinafter "City") and SUE AND KATHY LINE DANCE, a Sole
Proprietorship/Individual (“Contractor”) whose address is
CUPERTINO, CA 95014, and is made with reference to the following:
RECITALS:
A. On June 22, 2021, Agreement 21-001 (“Agreement”) was entered into by and between
City and Contractor for Line Dance Instruction.
B. City and Contractor desire to modify the Agreement on the terms and conditions set
forth herein.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as
follows:
1. Paragraph 3 of the Agreement is modified to read as follows:
Term. This contract begins on the Effective Date and ends on 06/30/2025 (“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.
2. Except as expressly modified herein, all other terms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
SIGNATURES CONTINUE ON THE FOLLOWING PAGE
2
IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement
to be executed.
CITY OF CUPERTINO
By
Title
Date
APPROVED AS TO FORM
City Attorney
ATTEST:
City Clerk
Date
SUE AND KATHY LINE DANCE
By
Title
Date
EXPENDITURE DISTRIBUTION
Item PO Number Amount
Base Amount 2022-86, 2023-68, 2024-66 105,000.00
Amendment 1 0.00
- - 105,000.00
Line Dance Instructor
Jun 24, 2024
Christopher D. Jensen
Director of Parks and Recreation
Jun 25, 2024
Jun 25, 2024
Updated 06/23/21
EXHIBIT C
AFFIDAVIT OF NO EMPLOYEES
State of California
County of Santa Clara
City of Cupertino
I, the undersigned, declare as follows:
I am an independent contractor and the owner of Sue and Kathy Line Dance.
I wish to enter into a services contract with the City of Cupertino. I am fully aware of the
provisions of section 3700 of the California Labor Code, which requires every employer to
provide Workers' Compensation coverage for employees in accordance with the provisions
of that Code. I am also aware that I must provide proof of workers’ compensation insurance
to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the
City of Cupertino’s contract.
I hereby certify that I do not have any employees nor will I have any employees working for
me or my business during the term of any service contract with the City of Cupertino. I am
not required to have Workers’ Compensation insurance.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
Executed on this ____day of ____________, 2024, at , California.
______________________________
PRINT NAME
______________________________
SIGNATURE
24 June Cupertino
Kathy Chang
Line Dance Instruction
Final Audit Report 2024-06-25
Created:2024-06-24
By:Webmaster Admin (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAy6i2kVHzdAeLPejTmtFqfFeeCgo4I2cQ
"Line Dance Instruction" History
Document created by Webmaster Admin (webmaster@cupertino.org)
2024-06-24 - 9:29:35 PM GMT- IP address: 35.229.54.2
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2024-06-24 - 9:30:22 PM GMT
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2024-06-25 - 0:07:56 AM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to for signature
2024-06-25 - 0:07:58 AM GMT
Email viewed by
2024-06-25 - 0:48:34 AM GMT- IP address: 74.125.209.33
Signer entered name at signing as Kathy Chang
2024-06-25 - 4:35:14 AM GMT- IP address: 24.6.36.94
Document e-signed by Kathy Chang (
Signature Date: 2024-06-25 - 4:35:16 AM GMT - Time Source: server- IP address: 24.6.36.94
Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature
2024-06-25 - 4:35:18 AM GMT
Email viewed by Christopher Jensen (christopherj@cupertino.org)
2024-06-25 - 5:03:20 AM GMT- IP address: 174.194.199.166
Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen
2024-06-25 - 2:43:12 PM GMT- IP address: 136.24.22.194
Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2024-06-25 - 2:43:14 PM GMT - Time Source: server- IP address: 136.24.22.194
Document emailed to Rachelle Sander (rachelles@cupertino.org) for signature
2024-06-25 - 2:43:16 PM GMT
Email viewed by Rachelle Sander (rachelles@cupertino.org)
2024-06-25 - 3:06:31 PM GMT- IP address: 104.47.74.126
Document e-signed by Rachelle Sander (rachelles@cupertino.org)
Signature Date: 2024-06-25 - 3:06:48 PM GMT - Time Source: server- IP address: 64.165.34.3
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2024-06-25 - 3:06:51 PM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2024-06-25 - 4:44:20 PM GMT- IP address: 104.47.74.126
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2024-06-25 - 4:44:28 PM GMT - Time Source: server- IP address: 64.165.34.3
Agreement completed.
2024-06-25 - 4:44:28 PM GMT