Agreement - Morgan Hill Unified School District - Funding Suport for SCYTF - Signed 2021-07-01DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
MORGAN HILL UNIFIED SCHOOL DISTRICT
SERVICES AGREEMENT
2021-22
THIS AGREEMENT ("Agreement") is made between Morgan Hill Unified School District, 15600
Concord Circle, Morgan Hill, CA 95037, hereinafter referred to as the DISTRICT, and the following
named service provider hereinafter referred to as VENDOR:
VENDOR NAME: City of Gilroy
DBA: South County Youth Task Force
ADDRESS:
7301 Hanna Street
MAILING ADDRESS: (if different than above)
CITY: Gilroy
PHONE: (408) 846-0362
STATE: CA
FAX: (408) 846-0387
ZIP: 95020
EMAIL ADDRESS: sandra.cruz@cityofgilroy.org
FEDERAL TAX I.D. OR SOCIAL SECURITY NUMBER: 94-6000340
Vendor is resvonsible for uvdatine contact information in a timely manner.
NOTE: Federal Regulations (Code Sections 6041 and 6209) require non -corporate recipients of $600.00 or
more to furnish their taxpayer identification number to the payer. The regulations also provide that a penalty
may be imposed or failure to furnish the taxpayer identification number. The DISTRICT requires your
federal tax identification number or Social Security Number, whichever is applicable, in order to comply with
these regulations.
Check appropriate box for federal tax classification:
OIndividual/sole proprietor OC Corporation
°Partnership °Trust/estate
()Limited Liability Company Type: O(C) (S) 0(P)
OS Corporation
CI other City Governmerr
Submittal of Documents: The VENDOR shall not commence the work under this Agreement until the
VENDOR has submitted and the DISTRICT has approved the certificate(s) and affidavit(s), and the
endorsement(s) of the insurance required as indicated below:
Signed Agreement
Insurance Certificates and Endorsements
W-9 Form
Workers' Compensation Certificate (if applicable)
Tuberculosis Clearance (if applicable)
Fingerprinting/Criminal Background Investigation (if applicable)
D1R # (if applicable)
Addendum for Technology Service Agreentent (if applicable)
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15600 Concord Circle • Morgan Hill, CA 95037* 408.201.6000 • Fax 408.201.6006
Docusign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
VENDOR:
City of Gilroy
TAX I.D. NUMBER:
94-6000340
1. TERM 7/1/2021 6/30/2022
This Agreement is effective on and terminates on or upon completion
of services, whichever occurs first.
VENDOR shall not undertake any work under this Agreement until this Agreement is reviewed and
approved by the DISTRICT's Board of Education, and VENDOR is in receipt of a signed Agreement.
2. TERMINATION
2.1 Without cause by DISTRICT. DISTRICT may, at any time, with or without reason, terminate this
Agreement and compensate VENDOR only for services satisfactorily rendered to the date of termination.
Written notice by DISTRICT shall be sufficient to stop further performance of services by VENDOR.
Notice shall be deemed given when received by the VENDOR no later than three (3) days after the day of
mailing, whichever is sooner.
2.2 Without cause by VENDOR. VENDOR may, upon thirty (30) day notice, with or without reason,
terminate this Agreement. Upon this termination, DISTRICT shall only be obligated to compensate
VENDOR for services satisfactorily rendered to the date of termination. Written notice by VENDOR
shall be sufficient to stop further performance of services to DISTRICT. VENDOR acknowledges that
this thirty (30) day notice period is acceptable so that the DISTRICT can attempt to procure the services
from another source.
2.3 With cause by DISTRICT. DISTRICT may tenninate this Agreement upon giving of written notice
of intention to terminate for cause. Cause shall include:
23.1. Material violation of this Agreement by the VENDOR; or
23.2. Any act by VENDOR exposing the DISTRICT to liability to others for personal injury or
property damage; or
23.3. VENDOR is adjudged bankrupt, VENDOR makes a general assignment for the benefit of
creditors or a receiver is appointed on account of VENDOR'S insolvency.
Written notice by DISTRICT shall contain the reasons for such intention to terminate and unless within
three (3) calendar days after that notice the condition or violation shall cease, or satisfactory arrangements
for the correction thereof be made, this Agreement shall upon the expiration of the three (3) calendar days
cease and terminate. In the event of this termination, the DISTRICT may secure the required services
from another VENDOR. If the expense, fees, and/or costs to the DISTRICT exceed the cost of providing
the services pursuant to this Agreement, the VENDOR shall immediately pay the excess expense, fees,
and/or costs to the DISTRICT upon the receipt of the DISTRICT'S notice of these expenses, fees, and/or
costs. The foregoing provisions are in addition to and not a limitation of any other rights or remedies
available.
3. SUBCONTRACT OR ASSIGNMENT.
Neither party shall assign, delegate or subcontract any part of this Agreement without the written consent
of the other party.
4. INTERPRETATION
In the event of any conflict or inconsistency between VENDOR'S agreement or documents and this
MORGAN HILL UNIFIED SCHOOL DISTRICT SERVICES AGREEMENT, the MORGAN HILL
UNIFIED SCHOOL DISTRICT SERVICES AGREEMENT shall prevail and supersede all other
agreements or contract language.
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15600 Concord Circle • Morgan Hill, CA 95037 • 408.201.6000• Fax 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
VENDOR:
City of Gilroy
TAX I.D. NUMBER:
94-6000340
5. INDEPENDENT CONTRACTOR STA-M
In the performance of the services to be provided, VENDOR is an independent contractor with the authority to
control and direct the performance of the details of the work, and this Agreement shall not be construed to
create the relationship of agent, employee, partnership, joint venture, or association. VENDOR understands
and agrees that it and all of its employees are not employees of the DISTRICT and are not entitled to benefits
to which DISTRICT employees are normally entitled, including, but not limited to, State Unemployment
Compensation, Workers' Compensation, vacation or sick pay.
6. TAX REPORTING / PAYMFN'.
VENDOR shall assume full responsibility for payment of all federal, state, and local taxes or contributions,
including, but not limited to, Unemployment Insurance, Social Security and Income Taxes with respect to
VENDOR'S employees. Pursuant to IRS regulations, the DISTRICT shall provide VENDOR in IRS
identified tax classification with an annual statement of compensation on the appropriate federal forms
(currently IRS Form 1099 Misc.).
7. REGULATIONS
VENDOR shall comply with all federal, state, and local laws, ordinances, regulations, permit requirements,
and Board of Education's policies and regulations in performance of this Agreement, including as set forth
herein at Paragraph 8.
8. ELSIGERPRINTTISLAND CRIMINAL RECORDS CHECK
The Fingerprinting/Criminal Background Investigation Certification must be completed and attached to this
Agreement prior to the VENDOR performing any of the services as listed in Item 12 of this Agreement.
DISTRICT retains authority to remove any VENDOR employee from DISTRICT site upon the
determination that he/she has not complied with this fingerprinting and background check requirement, or
has been convicted of a violent or serious felony, as defined in Education Code §45122.1. VENDOR
must notify the DISTRICT and remove any employee immediately should the VENDOR learn that an
employee working on a DISTRICT site has been convicted of a serious or violent felony, or sex offense.
Failure to provide notice as required above may result in cancellation of this Agreement by DISTRICT and
further legal action by the DISTRICT where applicable.
9. GOVERNING LAtiy
This Agreement shall be governed under the laws of the State of California. VENDOR hereby consents to the
jurisdiction of the state or federal courts of Santa Clara County, California.
10. MISCELLANEOUS
This Agreement contains the entire agreement between DISTRICT and VENDOR and supersedes any
and all prior discussions, understandings, and negotiations, whether oral or in writing. This Agreement
may not be modified or amended unless in writing and signed by both parties.
11. INSURANCE AND INDEMNIFICATION
VENDOR agrees to defend, indemnify, and hold harmless the DISTRICT, its Board of Education, officers,
employees and agents, individually and collectively, from and against all costs, losses, claims, demands,
suits, actions, payments, liabilities and judgments, including attorneys fees, arising from personal or bodily
injuries, property damage or otherwise, regardless of and however caused that may arise for any reason from
VENDOR'S performance of this Agreement.
VENDOR must keep in full force and affect a policy or policies of Workers' Compensation Insurance in
the amount or amounts required by applicable law.
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15600 Concord Circle • Morgan Hill, CA 95037. 408.201.6000• Fax 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CE00EB35143A
VENDOR:
City of Gilroy TAX LD. NUMBER:
94-6000340
During the term of this Agreement, VENDOR shall procure and maintain general liability, automobile
Liability, and professional liability (errors and omissions) from a California licensed insurer acceptable
to DISTRICT with per -occurrence limits of Si Million unless otherwise specified by the DISTRICT.
VENDOR shall provide DISTRICT with a Certificate(s) of Insurance evidencing such coverage. High
risk activities may require additional coverage as determined by the DISTRICT. Certificate Holder is
Morgan Hill Unified School District. VENDOR shall also provide an Additional Insured Endorsement,
naming Morgan Hill Unified School District as Additional Insured. Such insurance coverage shall be
primary insurance and any insurance or self-insurance maintained by the DISTRICT shall be non-
contributory. These certificates shall contain a provision that coverage afforded under the policy
will not be cancelled or allowed to expire until at least thirty (30) days prior written notice has been
delivered to the DISTRICT.
12. DESCRIPTION OF SERVICES (SCOPE OF WORK.
VENDOR shall supply all required payment and performance bonds and shall pay employees applicable
prevailing wages in accordance with state and federal law where required. VENDOR shall furnish, at its own
expense, all labor, materials, equipment and other items necessary to carry out the terms of this
Agreement. VENDOR shall provide the following services to DISTRICT:
This agreement will provide funding to support the work of the South County Youth Task Force (SCYTF).
The SCYTF is a collaboration that seeks to reduce juvenile delinquent behaviors, recruitment of youth into
gangs, and youth violence in South Santa Clara County. This agreement will provide matching funds to
compliment funding from the County of Santa Clara, the City of Gilroy and the Gilroy Unified School District.
SCYTF will provide the following services to MHUSD: Youth Outreach, Youth Groups, Case Management &
School Based Team Crisis Response and Trainings totaling $45,000. These services will be available to the
middle and high schools during the 2021-22 school year.
The City of Gilroy will invoice the MHUSD for a lump sum payment in the amount of $45,000 within 30 clays
prior to the end of the 2021-22 school year.
(Additional pages may be added and shall be marked Exhibit "A" and are incorporated herein by this reference).
13. COMPENSATION AND EXPENSES
DISTRICT agrees to pay the VENDOR for services satisfactorily rendered pursuant to this Agreement at the
rate set forth in Section 12 for a total fee not to exceed $ 45,000.00 . District shall pay
VENDOR according to the following terms and conditions:
13.1. Payment shall be made for all undisputed amounts in installment payments within thirty (30) days
after the VENDOR submits an invoice to the DISTRICT. VENDOR will only be paid after the MHUSD
Board of Education has approved/ratified this Agreement. -
13.2. VENDOR invoices will be subject to verification that services have been rendered and subject to
written approval by Jessie Swift, Coordinator Student Services
13.3. DISTRICT shall not be liable to VENDOR for any costs or expenses paid or incurred by VENDOR
in performing services for DISTRICT including but not limited to travel, professional development related
expenses, duplication, etc.
13.4. VENDOR shall not increase prices during the term of this Agreement.
13.5. All invoices must be submitted within 30 days of rendering services. DISTRICT reserves the right
to reiect invoices submitted for payment more than 30 days after services are performed.
14. OWNERSHIP OF WORK PRODUCT
VENDOR agrees all work prepared or produced during the course of this Agreement and arising from the
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15600 Concord Circle • Morgan Hill, CA 95037 • 408.201.6000 • fax 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
VENDOR:
City of Gilroy
TAX I.D. NUMBER:
94-6000340
services rendered (see Paragraph 12) shall be owned by and assigned to DISTRICT as its sole and exclusive
property.
15. AUDIT
VENDOR shall establish and maintain books, records, and systems of account, in accordance with generally
accepted accounting principles, reflecting all business operations of VENDOR transacted under this
Agreement. VENDOR shall retain these books, records, and systems of account during the Term of this
Agreement and for five (5) years thereafter. VENDOR shall permit the DISTRICT, its agent, other
representatives, or an independent auditor to audit, examine, and make excerpts, copies, and transcripts from
all books and records, and to make audit(s) of all billing statements, invoices, records, and other data related
to the services covered by this Agreement. Audit(s) may be performed at any time, provided that the
DISTRICT shall give reasonable prior notice to VENDOR and shall conduct audit(s) during VENDOR'S
normal business hours, unless VENDOR otherwise consents.
16. CERTIFICATES / PERMITS / LICENSES
VENDOR and all VENDOR'S employees or agents shall secure and maintain in force such certificates,
permits and licenses as are required by law in connection with the furnishing of services pursuant to this
agreement.
17. CONFIDENTIALITY
VENDOR and all VENDOR'S agents, personnel, employee(s), and/or subcontractor(s) shall maintain the
confidentiality of all information received in the course of performing the services. This requirement to
maintain confidentiality shall extend beyond the termination of this Agreement.
18. NOTICE
Any notice required or permitted to be given under this Agreement shall be deemed to have been given,
served, and received if given in writing and either personally delivered or deposited in the United States mail,
registered or certified mail, postage prepaid, return receipt required, or sent by overnight delivery service, or
facsimile transmission, addressed as follows:
DISTRICT VENDOR
Morgan Hill Unified School District City of Gilroy
15600 Concord Circle 7301 Hanna Street
Morgan Hill, CA 95037 Gilroy CA, 95020
ATTN: Glen Webb A'TTN: Sandra Cruz
19, ATTORNEY FFFS / COST
Should litigation be necessary to enforce any terms or provisions of this Agreement, then each party shall
bear its own litigation and collection expenses, witness fees, court costs and attorney's fees.
20. COMPLETION
The work completed herein must meet the approval of the DISTRICT and shall be subject to the
DISTRICT'S general right of inspection and supervision, in a manner consistent with VENDOR'S status as
an independent contractor, to secure the satisfactory completion thereof. Work must be completed in good
workmanship like manner and in accordance with the generally accepted standard of care in the industry.
21. SFVERARTLILy
If any provision of this Agreement shall be held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining portions hereof shall not in any way be affected or
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15600 Concord Circle • Morgan Hill, CA 95037 *408.201.6000• Fax 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CE00EB35143A
VENDOR: City of Gilroy
TAX 1.D. NUMBER: 94-6000340
impaired thereby, except where enforcement is inconsistent with the parties' intent.
22. RELEASE. DISCHARGE OR WAIVED
No release, discharge or waiver of any provision hereof shall be enforceable against or binding upon either
party hereto unless in writing and executed by both parties hereto. Neither the failure to insist upon strict
performance of any of the agreements, terms, covenants or conditions hereof, nor the acceptance of
monies due hereunder with knowledge of a breach of this Agreement, shall be deemed a waiver of any
rights or remedies that either party hereto may have or a waiver of any subsequent breach or default in any of
such agreements, terms, covenants or conditions.
23. EXECUTION IN COUNTERPARTS
This Agreement may be executed in several counterparts each of which shall be an original and all of which
shall constitute but one and the same agreement.
Any party signing this Agreement on behalf of the VENDOR hereby represents that he/she is
duly authorized by the VENDOR to execute this Agreement and that the VENDOR has agreed
to be bound by the provisions hereof.
City of Gilroy
Signature:
Name: Jimmy Forbis
Title: City Administrator
Signature:
Name: Thai Nam Pham
Title: Citv Clerk
Signature:
Name:
Title: City Attorney
('VENDOR")
Date:
MORGAN HILL UNIFIED SCHOOL DISTRICT ("DISTRICT") Date:
Signature:
Name: Kirsten Perez
Title: Deputy Superintendent and Chief Financial Officer
Date of board Approval:
Not withstanding the effective date of this Agreement set forth in Paragraph 1, this Agreement shall not be
considered accepted, approved or otherwise effective until 1) Board approval and 2) the required approvals
and certifications have been implemented, provided by, or submitted to the DISTRICT, as appropriate.
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15600 Concord Circle • Morgan Hill, CA 95037* 408.201.6000 • Fax 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-GEOOEB35143A
Name of VENDOR r ompany:
Representat
Signature:
15600 Concor
FINGERPRINTING / CRIMINAL BACKGROUND
INVESTIGATION CERTIFICATION
One of the three boxes below must be checked, with the corresponding certification provided, and this form attached to the
Services Agreement ("Agreement"):
Q(To be completed by authorized DISTRICT employee only) VENDOR'S employees will have only limited contact,
if any, with DISTRICT pupils and the DISTRICT will take appropriate steps to protect the safety of any pupils that
may come in contact with VENDOR'S employees so that the fingerprinting and criminal background investigation
requirements of Education Code § 45125.1 shall not apply to VENDOR for the services under this agreement. As an
authorized DISTRICT official, I am familiar with the facts herein certified, and am authorized to execute this
certificate on behalf of the DISTRICT (Education Code § 45125.1 (c))
Date: July 1, 2021
District Representative Name and Title
Signature
OThe fingerprinting and criminal background investigation requirements of Education Code § 45125.1 apply to
VENDOR'S services under this Agreement and VENDOR certifies its compliance with these provisions as follows:
VENDOR certifies that the VENDOR has complied with the fingerprinting and criminal background investigation
requirements of Education Code § 45125.1 with respect to all VENDOR'S employees, subcontractors, agents, and
subcontractors' employees or agents regardless of whether those employees are paid or unpaid, concurrently employed by
the DISTRICT, or acting as independent contractors of the VENDOR, who may have contact with DISTRICT pupils 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 Education Code § 45122.1. A complete and
accurate list of all employees who may come in contact with DISTRICT pupils during the course and scope of the
Agreement is attached hereto, or shall be provided to the DISTRICT prior to any employee having any contact with
DISTRICT pupils, and an updated list of all employees who may come in contact with DISTRICT pupils during the course
and scope of the agreement shall be provided to the DISTRICT within ten (10) days of DISTRICT's request.
QVENDOR'S services under this Agreement shall be limited to the construction, reconstruction, rehabilitation, or repair
of a school facility and although all Employees will have contact, other than limited contact, with DISTRICT pupils,
pursuant to Education Code § 45125.2 DISTRICT shall ensure the safety of the pupils by at least one of the following
as marked:
0 The installation of a physical barrier at the worksite to limit contact with pupils.
Continual supervision and monitoring of all VENDOR'S on -site employees of VENDOR by an employee of
QVENDOR, , whom the Department of Justice has ascertained has not been
convicted of a violent or serious felony.
QSurveillance of employees by DISTRICT personnel. (To be completed by authorized DISTRICT
employee only)
Date:
District Representative Name and Title
Signature
I am a representative of the VENDOR entering into this Agreement with the DISTRICT and I am familiar with the
facts herein certified, and am authorized and qualified to execute this certificate on behalf of the VE
OR.
Date: ! 1 Y0 GI
City of Gilroy
LeeAnn McPhillips, Director of Human Resources
-N f ac 1 Q r 1'r i.ptJ C evi
'Morgan I IIII, CA 95037 • 408.201.6000 •• ax 408.201.6006 �-� 'ease
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
MORGAN HILL UNIFIED SCHOOL DISTRICT
AMENDMENT TO SERVICE AGREEMENT
This Amendment to the Service Agreement is hereby entered into on by Morgan Hill
Unified School District, (hereinafter referred to as "DISTRICT"), and
(hereinafter referred to as VENDOR) for the following services:
The following changes and/or revisions will be reflected as follows to the original Service Agreement. All
prior agreements remain in force; Amendment only reflects a change in the following: (PLEASE ONLY
CHECK CHANGES THAT APPLY)
ORIGINAL PURCHASE ORDER NUMBER:
❑ TERM(S) OF CONTRACT: **
❑ DESCRIPTION OF SERVICE(S): **
❑ AMOUNT: ** Original: $ Total encumbered prior to this Amendment
Change: $ Additional amount to be encumbered
New Total: $ 0.00 Total of two lines above
❑ BUDGET CODE:
Old:
New:
(re-enter if same as above)
ID OTHER (PLEASE SPECIFY):
Amount
The CITY shall indemnify, defend, and hold harmless the DISTRICT, its officers, agents, and employees From any
claim, liability, loss, injury or damage arising out of, or in connection with, performance of this Agreement by the
CITY and/or its agents, employees or sub -contractors, excepting only loss, injury or damage caused by the sole
negligence or willful misconduct of personnel employed by the DISTRICT. It is the intent of the parties to this
Agreement to provide the broadest possible coverage for the DISTRICT. The CITY shall reimburse the DISTRICT
for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the CITY
** The Service Agreement Amendment is required to change: terms, description of services(s) or contractual amount
and may require approval by the Board of Education.
ORIGINAL BOARD APPROVAL DATE:
VENDOR Signature
Site / Department Administrator Signature
Kirsten Perez, Deputy Superintendent and CFO
BOARD AMENDED DATE (if required):
Date:
Date:
Date:
15600 Concord Circle. Morgan Hill, CA 408.201.6000 Fax: 408.201.6006
DocuSign Envelope ID: OFEBF746-AF98-4545-BAAF-CEOOEB35143A
TUBERCULOSIS CLEARANCE
The undersigned does hereby certify to the governing board of the DISTRICT as follows:
I am a representative of the VENDOR currently entering into this Agreement with the DISTRICT and I am familiar
with the facts herein certified, and am authorized and qualified to execute this certificate on behalf of the
VENDOR. VENDOR'S responsibility for tuberculosis clearance extends to all of its employees, subcontractors,
and employees of subcontractors corning into contact with DISTRICT pupils regardless of whether they are
designated as employees or acting as independent contractors of the VENDOR.
VENDOR certifies that at least one of the following items applies to the Scope of Work that is the subject of this
Agreement:
The VENDOR ensures that any person providing any portion of the services has completed the
Tuberculosis Risk Assessment Questionnaire (in accordance with California Education Code Section 49406
and Health and Safety Code Sections 121525-121555) and found that VENDOR does not have risk factors,
or if tuberculosis risk factors were identified, the patient has been examined and determined to be free of
infectious tuberculosis, by a physician or surgeon, within 60 days of Board approval of the Agreement, or
if previous contractor to the DISTRICT, within the last four (4) years. If there is however a positive
result, chest x-ray verification is required.
Upon the DISTRICT'S request, a complete and accurate list of VENDOR'S employees and of all of its
subcontractors' employees, who may come in contact with DISTRICT pupils during the course and scope
of the Agreement, will be required to furnished — indicating the date of each person's completion of the
questionnaire and if necessary physical examination.
QVENDOR'S Scope of Work under this Agreement is to be provided at an unoccupied school site only or
will not be done on any DISTRICT property where any employee and / or subcontractor or supplier of any
tier of Agreement shall come in contact with DISTRICT pupils.
DATE:
Name of VEND 0 . or Company: City of Gilroy
L n McPhillip , Director of Human Re
Represe Na tl. �
Signatur t 1101
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DocuSrgn Envelope ID: OFEBF746-AF98-4545-BAAF-CE00E335143A
WORKERS' COMPENSATION
CERTIFICATION
California law requires all employers to carry workers' compensation insurance, even if they have only one
employee. If you are the sole owner and you have no employees, or if your business is an out of state corporation
with no employees working in California, you may not be required to carry workers' compensation insurance. It is
your responsibility to comply with the law. If you do not know whether you are required to carry workers'
compensation insurance, find out by contacting the California Department of Industrial Relations ("DIR").
Information is also available on the DIR's website at http://dir.ca.gov.
Labor Code § 3700 in relevant part provides that every employer except the State shall secure the payment of
compensation in one or more of the following ways:
OBy being insured against liability to pay compensation by one or more insurers duly authorized to write
compensation insurance in this State.
0 By securing from the Director of Industrial Relations a certificate of consent to self -insure, which may be
given upon furnishing proof satisfactory to the Director of Industrial Relations of the ability to self -insure
and to pay any compensation that may become due to its employees.
OI understand that California Labor Code § 3700 et seq requires employers to provide workers'
compensation insurance coverage for any employees of my business. I hereby warrant that this business is
exempt from the California Labor Code provisions regarding workers' compensation insurance because it
has no employees working in California or is a sole -owner with no employees.
I am aware of the provisions of Labor Code § 3700 which requires every employer to be insured against liability for
workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will
comply with su jjh pr visions before commencing the performance of the Scope of Work of this Agreement.
DATE: IL l e 2fo
Name of VEND ' or Company: City of Gilroy
Represen . tive's - me an
Signatu . \1,A
itle: eeAnn McPhillips, Director of Human Resources
�
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