21-001 Phil 'N The Blanks
SHORT FORM ENTERTAINMENT AGREEMENT
CITY OF CUPERTINO
Parks & Recreation Department
10185 N. Stelling Road
Cupertino, CA 95014
408-777-3120
--USE OF THIS FORM IS ONLY VALID FOR AGREEMENTS UP TO $3,500.00--
Contractor Name: PHIL ‘N THE BLANKS
Contractor Authorized Representative: Philip Wiseman
By the signature of its Authorized Representative below, Contractor hereby agrees to the following:
A. SCOPE OF SERVICES. Contractor shall provide or furnish the following specified services
and/or materials: Family show concert performance. Contractor shall provide their own sound
system equipment.
Location: Memorial Park
Time: 3:00 pm to 10:00 pm
B. TERM. The services and/or materials furnished under this Agreement shall be provided from
7/22/2021 to 7/22/2021.
C. COMPENSATION. For the full performance of this Agreement, the City of Cupertino shall pay
Contractor a total of $1,500.00 in a lump sum to be paid following receipt of Contractor’s invoice.
D. EXHIBITS. The following attached exhibits hereby are made part of this Agreement:
- Exhibit "C" - Affidavit of No Employees
GENERAL TERMS AND CONDITIONS
1. 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 the Scope of 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 agreement.
2. General Liability Insurance. The undersigned shall maintain general liability insurance in an
amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal
injury, and property damage. Undersigned’s general liability policies shall be endorsed to
provide that City and its officers, officials, employees, and agents shall be additional insureds
under such policies.
3. Compliance with Laws. Contractor shall comply with all laws applicable to this Agreement
including, without limitation, laws regarding workers’ compensation, antidiscrimination, and
conflict of interest. If Contractor has no employees an affidavit to that effect shall be attached to
this agreement. If the scope of work involves providing services to children, the City of
Cupertino, Contractor Declaration shall be attached.
4. Assignment. Contractor may not assign, transfer, or subcontract this Agreement or any portions
thereof, without prior written consent of City.
5. Termination. City may terminate this agreement at any time. In the event of cancellation within
24 hours of the time Contractor is to begin providing services City shall pay contractor one half
of the total agreement amount unless cancellation occurs after Contractor’s personnel have
arrived at the location where services are to be performed in which case the total contract
amount shall be paid.
6. Interest of Contractor. It is understood and agreed that this Agreement is not a contract of
employment and, at all times, Contractor shall be deemed to be an independent contractor and
Contractor is not authorized to bind the City to any contracts or other obligations in executing
this Agreement. Contractor certifies that no one who has or will have any financial inter est
under this Agreement is an officer or employee of City. City shall have no right of control as to
the manner Contractor performs the services to be performed. Nevertheless, City may, at any
time, observe the manner in which such services are being performed by the contractor.
Contractor shall comply with all applicable Federal, State, and local laws and ordinances
including, but not limited to, unemployment insurance benefits, FICA laws, and the City
business license ordinance.
7. Changes. No changes or variations of any kind are authorized without the written consent of
the City.
CONTRACT COORDINATOR and representative for CITY shall be: Kelsey Christian.
May 5, 2020
IN WITNESS WHEREOF, the parties have executed this Agreement effective the date last signed
below.
CONTRACTOR
By ________________________
Name______________________
Title ______________________
Date_______________________
Tax I.D. No.: Refer to W9
CITY OF CUPERTINO
A Municipal Corporation
By ________________________
Name______________________
Title ______________________
Date_______________________
APPROVED AS TO FORM:
_____________________________
HEATHER M. MINNER
Cupertino City Attorney
ATTEST:
_____________________________
KIRSTEN SQUARCIA
City Clerk
Date ________________________
for
Philip Wiseman
Philip Wiseman
Jul 19, 2021
Phil 'n The Blanks band leader
Joseph D. Petta
Jul 21, 2021
Assistant Director of Parks and Recreation
Rachelle Sander
Jul 21, 2021
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: -
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with
Apex Insurance Services
P. O. Box 6450
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
TYPE: 2021 Summer Concerts
DATE(S): 7/15, 22, 29/21 & 8/5, 12/21
LOCATION: Memorial Park, 21121 Stevens Creek
Blvd, Cupertino CA 95014
*Liquor Liability Yes 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(ies) unless
amended as described in Special Conditions.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2021 EXPIRATION: JANUARY 1, 2022
COMMERCIAL GENERAL LIABILITY
General Aggregate Limit
Products & Completed Operations
Personal & Advertising Injury
Each Occurrence Limit
Damage To Premises Rented To You (Any One Premises)
Medical Payments (Any One Person)
Liquor Liability (If purchased)
Optional Limits Purchased
$1,000,000/$3,000,000
$2,000,000/$2,000,000
Damage To Property (If purchased)
$ 2,000,000
1,000,000
1,000,000
1,000,000
100,000
5,000
1,000,000
OCCURRENCE FORM
DEDUCTIBLE: NONE
SPECIAL CONDITIONS:
The following endorsements attached to
the Master Policy do not apply to this
Certificate Of Insurance:
MEGL643
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
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy
provisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: 7/7/21
MPIL 1039-CA 01 20 Page 1 of 2
EVANSTON INSURANCE COMPANY
IMPORTANT NOTICE
CALIFORNIA SURPLUS LINES NOTICE (D-2)
1. The insurance policy that you have purchased is being issued by an
insurer that is not licensed by the State of California. These companies
are called “nonadmitted” or “surplus lines” insurers.
2. The insurer is not subject to the financial solvency regulation and
enforcement that apply to California licensed insurers.
3. The insurer does not participate in any of the insurance guarantee
funds created by California law. Therefore, these funds will not pay
your claims or protect your assets if the insurer becomes insolvent
and is unable to make payments as promised.
4. The insurer should be licensed either as a foreign insurer in another
state in the United States or as a non-United States (alien) insurer. You
should ask questions of your insurance agent, broker, or “surplus
line” broker or contact the California Department of Insurance at the
toll-free number 1-800-927-4357 or internet website
www.insurance.ca.gov. Ask whether or not the insurer is licensed as a
foreign or non-United States (alien) insurer and for additional
information about the insurer. You may also visit the NAIC’s internet
website at www.naic.org. The NAIC – the National Association of
Insurance Commissioners – is the regulatory support organization
created and governed by the chief insurance regulators in the United
States.
5. Foreign insurers should be licensed by a state in the United States
and you may contact that state’s department of insurance to obtain
MPIL 1039-CA 01 20 Page 2 of 2
more information about that insurer. You can find a link to each state
from this NAIC internet website: https://naic.org/state_web_map.htm.
6. For non-United States (alien) insurers, the insurer should be
licensed by a country outside of the United States and should be on
the NAIC’s International Insurers Department (IID) listing of approved
nonadmitted non-United States insurers. Ask your agent, broker, or
“surplus line” broker to obtain more information about that insurer.
7. California maintains a “List of Approved Surplus Line Insurers
(LASLI).” Ask your agent or broker if the insurer is on that list, or view
that list at the internet website of the California Department of
Insurance: www.insurance.ca.gov./01-consumers/120-company/07-
lasli/lasli.cfm.
8. If you, as the applicant, required that the insurance policy you have
purchased be effective immediately, either because existing coverage
was going to lapse within two business days or because you were
required to have coverage within two business days, and you did not
receive this disclosure form and a request for your signature until after
coverage became effective, you have the right to cancel this policy
within five days of receiving this disclosure. If you cancel coverage,
the premium will be prorated and any broker’s fee charged for this
insurance will be returned to you.
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 PHIL ‘N THE BLANKS.
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 ____________, 2021, at , California.
______________________________
PRINT NAME
______________________________
SIGNATURE
Philip Wiseman
Monte SerenoJuly19
2021 Summer Concert Series - Phil 'n the
Blanks
Final Audit Report 2021-07-21
Created:2021-07-19
By:City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAaRFy7uxCMc4lYmVi0r2I1uacyvdnGGvc
"2021 Summer Concert Series - Phil 'n the Blanks" History
Document created by City of Cupertino (webmaster@cupertino.org)
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Agreement completed.
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