HomeMy WebLinkAboutAGENDA REPORT 2014 0917 CCSA REG ITEM 10Z ITEM 10.Z.
CITY OF M00RPARK,CALIFORNIA
City Council Mooting
MOORPARK CITY COUNCIL of 9-17-,20/4
AGENDA REPORT ACTION: d ,perry
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TO: The Honorable City Council
FROM: Jeremy Laurentowski, Parks and Recreation Director
By: Adriene Braddock, Recreation Supervisor
DATE: August 14, 2014 (CC Meeting September 17, 2014)
SUBJECT: Consider Agreement with Away We Grow Preschool, LLC, for
Contract Instructor Services at the Arroyo Vista Recreation Center
and Authorize the City Manager to Execute the Agreement
DISCUSSION
Alice Cantwell has been a contract instructor for the City since 1999, offering the Away
We Grow preschool program. In 2011, Alice Cantwell formed Away We Grow, LLC.
Classes for the 2014/2015 school year instructed by Away We Grow include the
following: Away We Grow 4-year old preschool class, Away We Grow 3-year old
preschool class, and two Toddler Time classes for childrenl8 months to 3-years old.
The anticipated payment amount to Away We Grow, LLC for the 2014/2015 school year
is approximately $101,704. Gross revenue for the program is anticipated to be
approximately $139,320. As the payment amount exceeds the City Manager's signature
authority, staff is requesting that the Council approve the agreement with Away We
Grow, LLC, and authorize the City Manager to execute the agreement. The subject
agreement is the City's form of standard contract instructor agreement used for all
recreation classes.
FISCAL IMPAC T
Payments to contract instructors are based on a percentage of revenue received.
$166,500 for instructor payments is included in the FY 2014/2015 Recreation Division
budget. Additional funding is not required to cover the cost of this Agreement.
STAFF RECOMMENDATION:
Approve the Agreement with Away We Grow, LLC, and authorize the City Manager to
execute the Agreement, subject to final language approval by the City Manager.
Attachment:
Agreement Away We Grow Preschool, LLC
465
City of Moorpark, Recreation Division
CONTRACT INSTRUCTOR AGREEMENT
For programs held at City's facilities
THIS AGREEMENT, made and entered into this day of
~~~~~~~~-
, 2014 between the CITY OF MOORPARK, a municipal
corporation located in the County of Ventura, State of California, hereinafter referred to
as "City" and AWAY WE GROW, a limited liability company, hereinafter referred to as
"Contractor."
WIT N ES S ETH:
WHEREAS, City offers a variety of recreational classes to the public; and
WHEREAS, Contractor desires to offer his/her class(es) to the public; and
WHEREAS, City shall contract for such services with an independent contractor
in anticipation that said contractor can provide such services in a manner acceptable to
the City; and
WHEREAS, Contractor is experienced and specializes in providing such services
and has the appropriate specialized experience, certifications and background to carry
out the duties involved.
NOW, THEREFORE, in consideration of the mutual covenants, benefits and
premises contained herein, the parties hereto agree as follows:
1. Scope of Services
Contractor agrees to perform appropriate instructional and teaching services and
to devote the number of hours necessary to perform the services in a competent,
reasonable and appropriate manner for class session(s) to be determined on a quarterly
basis as detailed in Scope of Services to be attached hereto and made a part of the
Agreement (Attachment A).
2. Compensation
Contractor shall be paid for the services rendered under this Agreement the fee
of 73% of the registration fees received (less participant refunds, credits, and transfers
as governed by the City's current "Community Services Recreation and Active Adult
Program Cancellation and Withdrawal Policy") for all class(es) conducted by Contractor.
Contractor may submit to City an invoice for payment due within five (5) business days
of the last class date. Payment for monthly classes shall be made by the 20th day of
each month. Payment for all other classes shall be made within thirty (30) days of last
class date. City shall not be liable to Contractor for any compensation whatsoever in
the event a class is cancelled. The percentage of registration fees retained by City shall
Away We Grow, LLC Page 1 of 7 466
be considered payment by Contractor for facility use fees, listing in the quarterly
recreation guide, registration services, and overhead costs associated with Contractor's
class( es).
3. Term
This Agreement shall be for the term of September 1, 2014, to May 31, 2015,
including classes which are held or will be paid during that period.
4. Termination or Suspension
This Agreement may be terminated with or without cause by City at any time with
no less than twenty-four (24) hours written notice of such termination. Contractor may
terminate this Agreement only by providing City with written notice no less than thirty
(30) days in advance of such termination. In the event of an emergency, as determined
by the sole discretion of City, this Agreement may be suspended by City at any time,
with no advance notice. If this Agreement is terminated or suspended prior to the end
of the term as identified herein, City agrees to pay Contractor for actual service
rendered pursuant to and in accordance with this Agreement.
5. General Conditions
A. Contractor shall establish fees to be charged to participants and shall not
permit anyone to participate therein who has not paid the required fees, unless
otherwise approved by the City. All registrations and fees, if any, shall be received by
an authorized member of the Recreation Division staff. No registrations or fees, with
the exception of class lab fees, shall be collected from class participants by Contractor.
Class lab fees shall be paid directly to Contractor and may be used only for the
purchase of class supplies. Participant supplies shall be the responsibility of each
participant as pre-determined by Contractor. City reserves the right to approve all fees
charged to participants.
B. Contractor may not circulate any written publicity without prior approval of the
Parks and Recreation Director or his/her designee. Recreation classes are published in
the City's quarterly recreation guide. Contractor shall furnish City with program content
and descriptive material as may be necessary to publicize the activity. Contractor may
not change course content without prior written approval by City.
C. City agrees to furnish the space required and/or designated facilities and
tables and chairs for use by Contractor while performing the services required under
this Agreement. Contractor agrees to furnish the necessary supplies and materials
required to perform the services required under this Agreement. At City's discretion,
Contractor may rent certain City owned equipment such as classroom rugs, audio/visual
equipment, and balls for a fee of $1.00 per class session. The City may provide
photocopying services for the Contractor at the current rates established by City
Council.
Away We Grow, LLC Page 2 of 7 467
Contractor shall take proper care of the facility and any equipment furnished by
City for the activity, and shall be responsible for damage caused thereto resulting from
misconduct, negligent acts, and improper use or care. Contractor shall be responsible
for cleaning tables, chairs, equipment, and floors following each class session so that
the facility and equipment are left in the same condition as existed prior to the start of
the class session. Facility use shall be as follows:
Cypress Room: Contractor shall be granted exclusive use of the back portion of
the room Monday at 9:00 a.m. through Friday at 2:00 p.m., and may leave equipment
set up Monday through Thursday evenings. Contractor shall have use of the front
portion of the room during program hours only, plus 45 minutes before and after
program hours for set up and clean up time. Contractor shall be permitted to decorate
the walls of the room with preschool appropriate items, so long as said decorations do
not in any way damage or mar the walls. In the event walls are damaged, Contractor
will be responsible for all costs associated with repairing said damage.
Jacaranda Room: Contractor shall be granted use of the room during program
hours only, plus 45 minutes before and after program hours for set up and clean up
time. Contractor must put away all supplies and equipment at the conclusion of class
each day. Contractor shall be permitted to decorate the walls of the room with preschool
appropriate items under the following conditions: 1) said decorations do not in any way
damage or mar the walls, 2) all other instructors scheduled in the Jacaranda Room
have no objections to said decorations, and 3) decoration must be removed entirely in
the event a renting party requests such.
Storage Space: City agrees to furnish storage space for Contractor's equipment
and supplies as follows: Up to one-half of the storage space in Storage Room #3
(adjacent to Cypress Room) and the 5 cabinets in the Jacaranda Room located along
the east wall. Contractor's supplies and equipment shall not be stored in any other
location. City does not accept any responsibility for damaged or missing equipment or
supplies belonging to Contractor. City reserves the right to reclaim storage space upon
30 days written notice to Contractor.
For certain class(es) requiring specialized equipment, Contractor's facility or
facilities may be used as agreed upon by City and Contractor as described in Scope of
Services.
D. Contractor shall establish minimum and maximum enrollment numbers for
each class. Minimum and maximum enrollment numbers shall be indicated for each
class detailed in the Scope of Services. Class(es) which fail to meet established
minimum numbers shall be cancelled. Maximum enrollment numbers may not exceed
established maximum room capacities.
E. Contractor shall be at the appropriate facility a minimum of ten (10) minutes
prior to the scheduled start time of each class, ready to commence instruction. In the
event Contractor will be absent or tardy, Contractor must notify enrolled participants and
City. A make-up class must be scheduled for each class missed.
Away We Grow, LLC Page 3 of 7 468
F. Contractor shall submit such reports as may be required by City in connection
with this Agreement, including but not limited to attendance sheets and participant
waiver of liability forms.
G. Contractor shall be responsible for the following expenses: the cost of
substitute teachers and assistants, supplies and materials, photocopies, additional
advertising, insurance, and transportation. Contractor shall be solely responsible for any
compensation due or payment to persons employed, or subcontracted, by him/her in
connection with the Scope of Services.
H. Contractor is and shall at all times remain as to the City a wholly independent
Contractor. The personnel performing the services under this Agreement on behalf of
Contractor shall at all times be under Contractor's exclusive direction and control.
Neither City nor any of its officers, employees, or agents shall have control over the
conduct of Contractor or any of Contractor's officers, employees, or agents, except as
set forth in this Agreement. Contractor shall not at any time or in any manner represent
that it or any of its officers, employees, or agents are in any manner officers,
employees, or agents of the City. Contractor shall not incur or have the power to incur
any debt, obligation, or liability against City, or bind City in any manner.
No employee benefits shall be available to Contractor in connection with the
performance of this Agreement. Except for the fees paid to Contractor as provided in
the Agreement, City shall not pay salaries, wages, or other compensation to Contractor
for performing services hereunder for City. City shall not be liable for compensation or
indemnification to Contractor for injury or sickness arising out of performing services
hereunder.
I. Contractor shall indemnify, defend (with counsel reasonably acceptable to City)
and hold harmless City, and any and all of its employees, officials and agents ("the
lndemnitees") from and against any liability (including liability for claims, suits, actions,
arbitration proceedings, administrative proceedings, regulatory proceedings, losses,
expenses or costs of any kind, whether actual, alleged or threatened, including
attorneys fees and costs, court costs, interest, defense costs, and expert witness fees),
where the same arises out of, are a consequence of, or are in any way attributable to, in
whole or in part, the negligence, willful misconduct, errors or omissions, or performance
of this Agreement by Contractor or by any individual, or entity for which Contractor is
legally liable, including but not limited to officers, agents, employees or subcontractors
of Contractor, except such damage as is caused by negligence of the City or any of its
officers, employees, servants, project coordinators, or agents.
Contractor agrees to obtain executed indemnity agreements with prov1s1ons
identical to those set forth here in this Section from each and every subcontractor, or
any other person or entity involved by, for, with, or on behalf of Contractor in the
performance of this Agreement. In the event Contractor fails to obtain such indemnity
obligations from others as required here, Contractor agrees to be fully responsible
according to the terms of this Section. Failure of City to monitor compliance with these
Away We Grow, LLC Page 4 of 7 469
requirements imposes no additional obligations on City and will in no way act as a
waiver of any rights hereunder. This obligation to indemnify and defend City as set forth
here is binding on the successors, assigns, or heirs of Contractor and shall survive the
termination of this Agreement or this Section.
City does not and shall not waive any rights that it may have against Contractor
by reason of this Section, because of the acceptance by City, or the deposit with City, of
any insurance policy or certificate required pursuant to this Agreement. The hold
harmless and indemnification provisions shall apply regardless of whether or not said
insurance policies are determined to be applicable to any losses, liabilities, damages,
costs, and expenses described in this Section.
J. Contractor shall maintain prior to the beginning of and for the duration of this
Agreement insurance coverage as specified in Attachment "B" attached hereto and
made a part of the Agreement.
K. Contractor may represent, perform services for, and be employed by such
companies and governmental entities as Contractor, in Contractor's sole discretion,
sees fit, with the exception of any firm or individual which may present a potential
conflict of interest with City. Contractor is responsible to advise City of any potential
conflicts which may arise in connection with contractual relationship with City.
L. It is acknowledged by the parties that the Contractor is uniquely qualified to
perform the services under this Agreement. Contractor agrees to furnish the necessary
labor required to perform the services required under this Agreement. Neither this
Agreement nor any duties or obligations under this Agreement may be assigned by
Contractor without the prior written consent of City.
M. This Agreement constitutes the entire Agreement of the parties concerning
the subject matter hereof and all prior Agreements or understandings, oral or written,
are hereby merged herein. This Agreement shall not be amended in any way except by
a writing expressly purporting to be such an amendment, signed, and acknowledged by
both of the parties hereto.
N. Should interpretation of this Agreement, or any portion thereof, be necessary,
it is deemed that this Agreement was prepared by the parties jointly and equally, and
shall not be interpreted against either party on the ground that the party prepared the
Agreement or caused it to be prepared.
0. No waiver of any provision of this Agreement shall be deemed, or shall
constitute, a waiver of any other provision, whether or not similar, nor shall any such
waiver constitute a continuing or subsequent waiver of the same provision. No waiver
shall be binding, unless executed in writing by the party making the waiver.
P. In the event any action, suit, or proceeding is brought for the enforcement of,
or the declaration of any right or obligation pursuant to this Agreement, or as a result of
any alleged breach of any provision of this Agreement, the prevailing party shall be
Away We Grow, LLC Page 5 of 7 470
entitled to recover its costs and expenses from the losing party, and any judgment or
decree rendered in such a proceeding shall include an award thereof.
Q. Any and all grievances, concerns, or complaints regarding facilities, staff,
equipment, scheduling, or any other aspect of any contractual class shall be submitted
in writing to the department director within five (5) days of occurrence.
R. No Contractor providing services, programs, or activities to the public on
behalf of the City shall discriminate against any person because of sex, race, color,
creed, national origin, or disability. Contractor shall comply with the Americans with
Disabilities Act and City policies pursuant thereto when providing said services,
programs, or activities.
S. Contractor and Contractor's employees, subcontractors, and volunteers, must
satisfactorily pass a fingerprinting process and background verification prior to
conducting any class(es) in which minors participate. Unless otherwise directed in
writing by City, Contractor agrees to have itself and any of its employees,
subcontractors, and volunteers providing instructor services to the City, pursuant to this
Agreement, submit to a fingerprinting process prior to execution of the Agreement and
publishing of classes in the recreation guide. The fingerprinting process shall be as
subscribed by the City and the cost shall be paid by the Contractor for itself and any of
its employees, subcontractors, and volunteers. In the event City is charged for
fingerprinting services for Contractor, or Contractor's employees, subcontractors, and
volunteers, City shall notify Contractor of said charges, and Contractor agrees to fully
reimburse City for said charges within thirty (30) days. A Contractor that fingerprints its
own employees, subcontractors, and volunteers shall provide written documentation
that it is registered with the Department of Justice hereinafter referred to as "DOJ'' in
compliance with Section 11105.3 of the California Education Code and,
accordingly, submits to the DOJ fingerprints of all employees, volunteers, contractors,
or subcontractors prior to any work assignments. Contractor shall not use an employee,
subcontractor, or volunteer who fails to receive a satisfactory fingerprint report (e.g., a
fingerprint report showing conviction of certain criminal offenses that would make it
illegal for such individuals to have direct supervisory or disciplinary authority over
minors) in the service of this Agreement.
T. Contractor shall keep informed of, and shall comply with, all federal, state,
and local laws and regulations which in any manner affect her/his performance under
this Agreement, including but not limited to the American with Disabilities Act and
Occupational Health and Safety Administration laws and regulations. Contractor shall
conduct said services in a professional and dignified manner and shall not violate, nor
permit any person participating therein to violate, any rule, regulation or ordinance of
City, the State or the Federal Government.
U. Although Contractor acknowledges that they are not an employee of the City,
Contractor agrees to comply with the provisions of Public Resources Code Section
5163, and hereby certifies that at the time of approval of their initial Agreement with the
City, they have been found to be free of communicable tuberculosis (TB) based on a
negative TB skin test by a qualified medical professional within the two-year time period
preceding execution of the agreement. Contractor also certifies that they will comply
Away We Grow, LLC Page 6 of 7 471
with the requirements of Section 5163 to undergo a TB examination at least once each
four years following execution of the initial contract instructor agreement with the City,
so long as the contractor remains skin test negative and free of communicable
tuberculosis. Contractor shall immediately notify the City in writing upon receipt of a
positive skin test for TB and a finding of communicable tuberculosis, and the agreement
will be suspended or terminated by City without further notice pursuant to the provisions
in the Agreement.
V. This Agreement is made, entered into, executed and is to be performed in
Moorpark, Ventura County, California, and any action filed in any court or for arbitration
for the interpretation, enforcement or other action of the terms, conditions or covenants
referred to herein shall be filed in the applicable court in Ventura County, California.
IN WITNESS HEREOF:
CITY OF MOORPARK: AWAY WE GROW, LLC:
Steven Kueny, City Manager Alice Cantwell, Owner
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City of Moorpark, Recreation Division
Attachment A
SCOPE OF SERVICES
Fall 2014
Instructor Class Schedule
Instructor Name: Alice Cantwell -------------------------------Business Name: _A_w_a~y_W_e_G_ro_w _________________________ _
Address: 11664 Sagewood Drive
City: Moorpark State: CA Zip: _9_3_0_2_1 ______ ~
Business Phone: 805-368-2021 Alternate Phone: -------------Em a i I:
This Agreement made and entered into by the City of Moorpark ("City") and the above-named person,
partnership or corporation engaged as an independent Contractor ("Contractor") in offering instructional
services for personal services to be rendered for City as an instructor of recreational classes. Contractor
agrees to perform appropriate instructional and teaching services and to devote the number of hours
necessary to perform the services in a competent, reasonable, and appropriate manner for the session(s)
as follows:
CLASS TITLE: Away We Grow PreSchool
Class description: Your little one will experience a variety of early childhood activities including arts &
crafts, games, finger plays, music, stories, circle time, and more in a safe, fun
learning environment. This program is designed to develop the child's large and
fine motor skills, social skills, speech and language, and thought processes such
as color, shape, number, and letter recognition. Bring a sack lunch.
Instructor Name: Away We Grow Ages: 3-5 Min/Max: 16-24
Location: AVRC, Cypress Room
4-year old class
CODE
211201.01
211201.02
211201.03
211201.04
211201.05
211201.06
211201.07
211201.08
211201.09
Lab Fee: $65
3-year old class
CODE
211202.01
211202.02
211202.03
211202.04
211202.05
211202.06
211202.07
211202.08
211202.09
Lab Fee: $55
DATES
September
October
November
December
January
February
March
April
May
DAYS
M/W/F
M/W/F
M/W/F
M/W/F
M/W/F
M/W/F
M/W/F
M/W/F
M/W/F
TIMES
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
9:00 a.m.-2:00 p.m.
(noon on Friday)
FEE
$275
$275
$275
$275
$275
$275
$275
$275
$275
No Class: 9/1, 9/25, 11/10, 11/11, 11/24-28, 12/22-1/2, 1/19, 2/13, 2/16, 3/30-4/6,
5/1, 5/25
DATES DAYS TIMES FEE
September Tu/Th 9:00 a.m.-2:00 p.m. $230
October Tu/Th 9:00 a.m.-2:00 p.m $230
November Tu/Th 9:00 a.m.-2:00 p.m. $230
December Tu/Th 9:00 a.m.-2:00 p.m. $230
January Tu/Th 9:00 a m.-2:00 p.m. $230
February Tu/Th 9:00 a.m.-2:00 p.m. $230
March Tu/Th 9:00 a.m.-2:00 p.m. $230
April Tu/Th 9:00 a.m.-2:00 p.m. $230
May Tu/Th 9:00 a.m.-2:00 p.m. $230
No Class: 9/1, 9/25, 11/10. 11 /11, 11 /24-28, 12/22-1 /2, 1 /19, 2/13, 2/16, 3/30-4/6,
5/1, 5/25
Page 1of2 473
Away We Grow
Fall 2014
Class description: Toddler time is an early childhood class designed for children 18 to 36 months of
age.
Instructor Name: Away We Grow Ages: 18 mo-3yrs Min/Max: 8/12
Location: AVRC, Jacaranda Room
Monday/Wednesday Class
CODE DATES
211203.01 September
211203.02 October
211203.03 November
211203.04 December
211203.05 January
211203.06 February
211203.07 March
211203.08 April
211203.09 May
Tuesday/Thursday Class
CODE DATES
211204.01 September
211204.02 October
211204.03 November
211204.04 December
211204.05 January
211204.06 February
211204.07 March
211204 08 April
211204.09 May
Lab Fee: $45 No Class:
DAYS
M/W
M/W
M/W
M/W
M/W
M/W
M/W
M/W
M/W
TIMES
9:00 a.m.-11:00 a.m.
9:00 a.m.-11:00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
9:00 a.m.-11 :00 a.m.
FEE
$140
$140
$140
$140
$140
$140
$140
$140
$140
DAYS TIMES FEE
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00a.m.-11:00a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
Tu/Th 9:00 a.m.-11 :00 a.m. $140
9/1, 9/25, 11/10, 11/11. 11/24-28, 12/22-1/2, 1/19, 2/13, 2/16, 3/30-4/6,
5/1, 5/25
I authorize City to prorate classes: ____ Yes or ____ No
Signature:----------------Date: ______ _
Print Name: ----------------
Page 2 of 2
474
Attachment B
Insurance Requirements
As a condition precedent of the effectiveness of this Agreement, Contractor shall procure, and
thereafter maintain in full force and effect at Contractor's sole cost and expense, the following
types and amounts of insurance:
1. A general liability insurance policy written with a company acceptable to City and authorized
to do business in the State of California. Such policy shall provide for a minimum coverage of
One Million Dollars ($1,000,000.00) for bodily injury or death of any person or persons in any
one occurrence, and One Million Dollars ($1,000,000.00) for loss by damage or injury to
property in any one occurrence and shall include automobile coverage. The policy shall
contain a provision providing for a broad form of contractual liability, including Product Liability
coverage if food and beverages are dispensed on Premises. The policy or policies shall be
written on an occurrence basis. The policy shall name Contractor as the insured and the City
of Moorpark, its officials, employees, and agents as an additional insured. The policy shall
also provide that the City shall be notified in writing, at least thirty (30) days prior to any
termination, amendment cancellation or expiration thereof. Contractor shall furnish City
evidence of all insurance policies required by this Agreement in the form of a Certificate of
Insurance and additional insured endorsement. It is acknowledged by the parties of this
Agreement that all insurance coverage required to be provided by Contractor or any
subcontractor, is intended to apply first and on a primary, non-contributing basis in relation to
any other insurance or self-insurance available to the City.
Contractor may elect to purchase insurance through the City's provider at the current rate.
Contractor shall pay to City insurance fees due on or before the first class date. If said
insurance fees are not paid prior to the first class date, insurance fees shall be deducted from
Contractor's compensation.
I shall maintain insurance coverage as described above.
(Contractor's Signature): ______________ _
I elect to purchase insurance through the City's provider and to pay all costs associated with
the purchase of said insurance.
(Contractor's Signature): ______________ _
2. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including symbol
1 (Any Auto) or the exact equivalent. Limits are subject to review, but in no event to be less
than State statutory limits per accident. If Contractor owns no vehicles, this requirement may
be satisfied by a non-owned auto endorsement to the general liability policy described above.
If Contractor or Contractor's employees, subcontractors, or volunteers will use personal autos
in any way in performing the services under this Agreement, Contractor shall provide evidence
of personal auto liability for each such person.
3. Workers' Compensation on a state-approved policy form providing statutory benefits as
required by law with employer's liability limits no less than one million dollars ($1,000,000) per
accident or disease. A Workers' Compensation Insurance Certificate shall be filed with City
before beginning work, unless Contractor submits a written certification that no one other than
Contractor, or subcontractors, are performing any services under this Agreement.
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Workers' Compensation Statement
I certify that in the performance of this Agreement, I shall not employ any person in any
manner so as to become subject to the Workers' Compensation laws of the California Labor
Code, and agree that if I should become subject to the Workers' Compensation provisions of
the California Labor Code, I shall forthwith comply with those provisions.
Contractor's Signature: _____________ Date: ______ _
Print Name: -----------------
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