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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