Loading...
HomeMy WebLinkAboutA6335 - PALM SPRINGS BOXING CLUB - TEMPORARY USE AT 225 EL CIELO AND LONG TERM USE OF 3601 E MESQUITE AVE FACILITY USE LICENSE (STEVEN QUINONEZ; PALM SPRINGS BOXING CLUB) This Facility Use License("License") is made and entered into this 5th day of April, 2013, by and between the City of Palm Springs("City") and Steven Quinonez, an individual, doing business as Palm Springs Boxing Club("Quinonez"),concerning the use of the city facilities at 225 El Cielo Rd., and the Demuth Community Center("Facility"). RECITALS A. The City and Quinonez are mutually interested in providing needed amenities and community services to all residents of Palm Springs. B. Quinonez will be afforded the opportunity,on the same basis as other lawful users, to provide services, including sports and recreation classes desired by the community. C. Quinonez desires to use a portion of the Demuth Community Center ("Facility"), located at 3601 East Mesquite Road,Palm Springs,for the purpose of conducting boxing classes and training(the"Program"). The Parties understand that space at the Facility will not be available until later in the year. Until such time as the Facility is available for use under this License, Quinonez desires to use the City building located at 225 El Cielo Road(the"225 Building"),in Palm Springs on an interim,short term basis,to conduct the Program. D. Quinonez now desires to enter into this License to obtain access and use of the Facility, according to the terms and conditions stated herein. E. The City desires to secure Quinonez commitment to operate in a manner consistent with the City's recreation programs for the provision of recreation services to the residents of Palm Springs on terms that will provide appropriate disclosures and assurances to the City and the community regarding the overall integrity and safety of the program. NOW, THEREFORE,the City and Quinonez agree as follows: AGREEMENT 1. TERM. 1.1. Term. This License shall be in full force and effect beginning April 4, 2013 and ending March 31,2014. This License can be extended or superseded by a subsequent License upon mutual consent of the Parties. 1.2. Termination. City or Quinonez may terminate this License at any time, with or without cause, upon thirty (30) days' written notice to the other parry. In the event of a material breach, the non-breaching party may terminate this License after giving the other party fifteen(15) days' notice to cure. 2. FACILITY USE. 2.1. Facility Use. City grants Quinonez the use of the 225 Building until such time as the 772565.1 1 Pv: Facility is ready for Quinonez'occupancy. Once the City provides Quinonez notice,Quinonez will be granted use of the Martial Arts Room at Facility,as identified in Exhibit"A",and within fifteen (15) days of such notice, Quinonez shall vacate the 225 Building. The use of the 225 Building and the Facility shall be subject to the Rules and Regulations outlined in Exhibit "B." 2.2. Fees and Charges for Facility Use. Quinonez acknowledges that the fair market value of this License is$750.00 per month. In lieu of payment of a monthly charge for the use ofthe Facility, Quinonez agrees that each participant in the Program shall be required to purchase an annual Recreation Membership from the City. In addition, Quinonez agrees to pay to the City an amount equal to thirty(30%)of all fees,charges,or payments of any kind from all participants in the Program. This percentage payment shall be paid monthly, on or before the fifth of every month. Each payment will be appropriately documented to the satisfaction of the City's Finance Director. 2.3. Personal Property. Quinonez may deposit boxing equipment and supplies,including without limitation a boxing ring,inside the martial arts room. Such boxing equipment shall remain the personal property of Quinonez. City shall not be responsible for the security of such equipment and any losses of such equipment shall be the sole responsibility of Quinonez. 2.4. Mailbox. City permits Quinonez's use of a designated mail slotlinbox at the front reception counter area of the Facility. 2.5. Utilities. Quinonez is responsible for establishing telephone lines, in separate accounts from the City,and is responsible for payment of monthly accounts related to these services. All other utilities shall be provided by the City. Quinonez expressly waives any and all claims to the City for compensation for any and all losses or damages sustained for any reason or any defect, deficiency or impairment of any utility system, water supply system, drainage system, electrical apparatus or wires serving the Facility with respect to the loss of the facility for Quinonez functions. 3. SECURITY AND BACKGROUND CHECKS. 3.1. Background Checks. Any person having supervisory or disciplinary authority over any minor is required to obtain a criminal background screening in accordance with the procedures outlined in California Public Resources Code Section 5164. Such persons shall be disclosed in the attached Exhibit "C". Copies of all criminal background checks shall be made available to the City upon request. 3.1.1. Supplemental Questions. Each employee or volunteer having supervisory or disciplinary authority over any minor must complete the supplemental questions attached as Exhibit "D" to this License. 3.1.2. Submission and Fingerprints. Quinonez must submit a completed copy of Exhibit"D"to the City and arrange for the fingerprinting of each employee and volunteer before this License may be executed by the City. During the first year that the City requires the background screening for a particular individual,the screening shall include screening by the federal government. All subsequent years that the City requires a background check on that same individual, the screening need only be performed by the state government. 3.2. Alarm and Security. Quinonez representatives are responsible for locking the building and setting the alarm upon departure in those instances that Quinonez staff are the last occupants in the facility Quinonez shall identify to the City,in writing,one or more representatives 772565.1 2 responsible for securing the building and setting the alarm upon departure. Quinonez shall comply with Chapter 5.02 of the Palm Springs Municipal Code as an"alarm user"and shall be liable for all false alarm response fees pursuant to Palm Springs Municipal Code § 5.02.075 resulting from Quinonez's failure to set the alarm under circumstances required by this License. 4. LIABILITY AND INSURANCE. 4.1. Minimum Insurance. Quinonez shall procure and maintain, at its sole cost and expense, in a form and content satisfactory to the City Attorney, during the entire term of this License, including any extension thereof, the following policies of insurance: 4.1.1. Comprehensive General Liability Insurance. A policy of comprehensive general liability insurance in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in an amount not less than Two Million Dollars ($2,000,000.00) in aggregate. Insurance companies shall have an AM Best's Guide Rating of A-, Class VII or better. 4.1.2. Workers' Compensation Insurance. To the extent required by Labor Code § 3700, Quinonez shall procure and maintain workers' compensation insurance in the amount and to the extent required by law. 4.2. Proof of Insurance.Proof of the insurance required under Section 4 shall be provided to City prior to the execution of this License. 4.3. Primary Insurance. Quinonez's insurance coverage shall be primary with respect to the City and its respective elected officials, officers, employees, agents, and volunteers. Any insurance or self-insurance maintained by City and its respective elected officials, officers, employees, agents, and volunteers shall be in excess of Quinonez's insurance and shall not contribute with it. For Workers'Compensation and Employer's Liability Insurance only,the insurer shall waive all rights of subrogation and contribution it may have against City,its elected officials, officers, employees, agents, and volunteers. 4.4. Endorsements. Quinonez shall obtain an Additional Insured Endorsement designating the City,its officers,officials,employees,agents,and volunteers as additional insureds for liability arising out of this License. All endorsements shall reference that Quinonez's insurance shall be primary and non-contributory, as outlined in Section 4.3. 4.5. Amendment of Insurance Policy. Quinonez shall not amend,or allow to be amended, any insurance policy under this License if such amendment is not consistent with the minimum insurance requirements contained herein. Such amendment without the consent of the City shall be considered a material breach of this License and City may immediately terminate this License upon such occurrence. 4.6. No Cancellation of Insurance Policy. Quinonez shall not cancel, or allow to be cancelled, any insurance policy required under this License. If said policies of insurance are cancelled, Quinonez shall, prior to the cancellation date, immediately obtain new insurance consistent with the requirements of this License and immediately submit evidence of such insurance to the City. 4.7. United States Amateur Boxing Insurance. Each participant in the Program shall be enrolled as a member of the United States Amateur Boxing("USA Boxing")and shall be covered 772565.1 3 by the USA Boxing insurance program for accidental injury, medical and dental expense, and accidental death and dismemberment. 4.8. Waiver of Liability. Quinonez shall have each participant,or in the case of a minor, the parent or legal guardian of the participant shall at least annually execute a waiver of liability in the form attached as Exhibit"E"or as approved by the City Attorney,and deliver an original copy to the City. The waiver shall hold harmless Quinonez and the City and the City's officers, employees, and agents. 4.9. Failure to Obtain Valid Insurance During Use of the Facility. If Quinonez and/or the Participants are not minimally insured,as required under Section 4,Quinonez shall be considered in material breach of this License and City may immediately terminate this License. 4.10. No Limitation. The provisions of this Section 4 shall not be construed as limiting in any way the extent to which Quinonez may be held responsible for the payment of damages to any persons or property resulting from Quinonez's activities or the activities of any person or persons for which Quinonez is otherwise responsible. 4.11. Liabili . Quinonez agrees that City shall not be liable for any damage or injury to persons or property arising out of the use of the Facility by Lessee, its agents and employees, invitees, or visitors except that occasioned by the negligence or act of City, its agents,employees, servants,contractors,or subcontractors. Quinonez will indemnify and save City harmless from all liability and loss on account of any such damage or injury;but Quinonez shall not be liable for any damage or injury occasioned by any failure of City to comply with its obligations under this License or by reason of the sole negligence of City, its agents, servants, employees, contractors, or subcontractors. 5. INDEMNIFICATION AND DEFENSE. 5.1 Indemnification. Quinonez agrees to indemnify the City, its officers, agents and employees against,and shall hold and save each of them harmless from,any and all actions,suits, claims, damages to persons or property, including injury or death to any person, losses, costs, penalties, obligations, errors, omissions or liabilities (herein "Claims") that may be asserted or claimed by any persons,fimi or entity arising out of or related to this License or Quinonez activities at the Facility, except to the extent that the Claim arises from the sole negligence or willful misconduct of the City, its officers, agents or employees. 5.2 Defense. Quinonez agrees to defend, with counsel acceptable to City, the City, its officers,agents and employees against any Claims that may be asserted or claimed by any persons, firm or entity arising out of or related to this License or Quinonez activities at the Facility,except to the extent that the Claim arises from the sole negligence or willful misconduct of the City, its officers, agents or employees. 5.3 Costs Associated with Indemnification and Defense. Quinonez shall be responsible for all costs incurred by the City that are associated with the indemnification or defense of City by Quinonez, including any costs associated with the use of City resources, including lost time by employees,expended in furtherance of the indemnification or defense. 6. GENERAL PROVISIONS. n25a5A 4 6.1. Notice. All notices,demands and requests which may be given or which are required to be given by any party to this License,and any exercise of a right of termination provided by this License,shall bz in writing and shall be deemed effective either:(1)on the date personally delivered to the address blow,as evidenced by written receipt therefore,whether or not actually received by the person to whom addressed; (2) on the third(3rd) business day after being sent,by certified or registered mail,,return receipt requested,addressed to the intended recipient at the address specified below; (3) on the first (1st) business day after being deposited into the custody of a nationally recognized overnight delivery service (i.e., FedEx Corporation, UPS, or DHL) addressed to such parry at the address specified below;or(4)on the business day sent via facsimile transmission to the facsimile numtfers below, as evidenced by a printed confirmation of the successful electronic transmission of the message prior to 2:00 p.m.(Pacific Standard Time),or otherwise delivery shall be considered ti>be on the following business day. For purposes of this section,the addresses of the parties for all natices are as follows: 6.1.1. City. City Manager C,.ity of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs,CA 92262 ('760) 323-8299 6.1.2. Quinonez. Steven Quinonez Palm Springs, CA 92262 ('760) 835-5048 Quinonez shall be responsible for notifying the City, in writing, of any changes in Quinonez's address. 6.2. —('alifomia Law. This License shall be construed and interpreted both as to validity and to perforInance of the parties in accordance with the laws of the State of California. Legal actions concerning any dispute,claim or matter arising out of or in relation to this License shall be instituted in the Superior Court of the County of Riverside, State of California. or any other appropriate colirt in such county, and Quinonez covenants and agrees to submit to the personal jurisdiction of much court in the event of such action. 6.3. NVaiver. No delay or omission in the exercise of any right or remedy by a non- defaulting part;r on any default shall impair such right or remedy or be construed as a waiver. A parry's consent,to or approval of any act by the other party requiring the party's consent or approval shall not be dcQmed to waive or render unnecessary the other party's consent to or approval of any subsequent act.`, Any waiver by either party of any default must be in writing and shall not be a waiver of any Ether default concerning the same or any other provision of this License. 6.4. -.fights and Remedies are Cumulative. Except with respect to rights and remedies expressly decl5xed to be exclusive in this License, the rights and remedies of the parties are cumulative aril the exercise by either party of one or more of such rights or remedies shall not preclude the ckercise by it, at the same or different times, of any other rights or remedies for the 772565.1 5 same default or any other default by the other party. 6.5. Legal Action. In addition to any other rights or remedies,either party may take legal action, in law or in equity, to cure, correct or remedy any default, to recover damages for any default,to compel specific performance of this License,to obtain declaratory or injunctive relief,or to obtain any other remedy consistent with the purposes of this License. 6.6. Attorney's Fees. If either party to this License is required to initiate or defend or made a party to any action or proceeding in any way connected with this License,the prevailing parry in such action or proceeding, in addition to any other relief that may be granted, whether legal or equitable,shall be entitled to reasonable attorneys' fees.Attorneys'fees shall include attorneys'fees on any appeal, and, in addition, a party entitled to attorneys' fees shall be entitled to all other reasonable costs for investigating such action, taking depositions and discovery, and all other necessary costs the court allows that are incurred in such litigation.All such fees shall be deemed to have accrued on commencement of such action and shall be enforceable whether or not such action is prosecuted to judgment. 6.7. Non-Liability of City Officers and Employees. No officer or employee of the City shall be personally liable to Quinonez, or any successor-in-interest, in the event of any default or breach by the City or for any amount that may become due to Quinonez or to its successor,or for breach of any obligation of the terms of this License. 6.8. Conflict of Interest. No officer or employee of the City shall have any financial interest, direct or indirect, in this License nor shall any such officer or employee participate in any decision relating to the License that affects his financial interest or the financial interest of any corporation,partnership or association in which he is directly or indirectly interested,in violation of any state statute or regulation. Quinonez warrants that it has not paid or given and shall not pay or give any third party any money or other consideration for obtaining this License. 6.9. Covenant Against Discrimination. Quinonez covenants that,by and for himself,his heirs,executors, assigns and all persons claiming under or through it,that,to the extent permitted by law,there shall be no discrimination against or segregation of any person or group of persons on account of race, color, creed, religion, gender, marital status, sexual preference, domestic partnership status, national origin or ancestry in the performance of this License. 6.10. Compliance with Governing Law. Quinonez shall comply with all applicable laws, codes,ordinances and regulations of the federal, state, and local government. 6.11. Interpretation. The terms of this License shall be construed in accordance with the meaning of the language used and shall not be construed for or against either party by reason of the authorship of this License or any other rule of construction that might otherwise apply. 6.12. Modification. This License may be amended at any time by the mutual consent of the parties by an instrument in writing. 6.13. Severability. In the event that any one or more of the phrases, sentences, clauses, paragraphs or sections contained in this License shall be declared invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this License hereby declared as severable and shall be interpreted to cant'out the intent of the parties 772565.1 6 hereunder unless the invalid provision is so material that this invalidity deprives either party of the basic benefit of their bargain or renders this License meaningless. 6.14. Successors. The terms and conditions contained herein shall be binding on and inure to the parties to this License,their administrators,representatives,successors and assigns,except as otherwise provided in this License. 6.15. Assignment. Quinonez may not assign or transfer his interest under this License without City's prior written consent, which consent may be withheld, conditioned or delayed in City's sole and absolute discretion. Any attempted assignment,sublet or transfer made in violation of this provision shall be void. 6.16. Venue. Any action at law or in equity brought by either party to this License regarding the subject matter of this License shall be filed in the Superior Court of the State of California for the County of Riverside, Indio Branch. 6.17. Headings. The headings used in this License are employed solely for convenience of the parties and are not to be used as an aid in interpretation. 6.18. Relationship. Nothing contained in this Lease shall be construed as creating the relationship of principal and agent or of partnership or joint venture between City and Quinonez. 6.19. Entire License. This License constitutes the entire License between City and Quinonez. There are no oral agreements between the parties hereto affecting this License. This License supersedes and cancels any and all previous negotiations, arrangements, agreements and understandings, if any,between the parties, and none shall be used to interpret this License. IN WITNESS THEREOF,these parties have executed this License on the day and year shown below. CITY OF P SPRING 5; Date: Lohn Ra mon , hector A TED: Date: `� '� U�`� �j2 es Thompson,City Clerk APPROVED BY DEPARMENT HEAD APPR S TO FORM: c,\���•Il� Date: O¢- 4 Doug . Holland, City Attorney STEVEN QU NE (dba Palm g Club) ~ Date: Steven Quino z Ll 772565.1 7 EXHIBIT "A" (FACILITY) 772565.1 TIP it I - i Omf rr - `� I' Y '9 L 1 i 1 , t ary•�MBOIi].FibAa.SI.Caeaymogr+lv..Cus .,Daa.T.I.NLs.Digbl Mao g� `gPLM So Exhibit A-1 �84ft CityGIS Temporary Boxing Club N Location Copyright m 2006 All Rights Reserved. The information contained herein Is the proprietary property of the contributor supplied under license and may not be approved except as licensed by Digital Map Products. 1 tC)O� �C�?� C�OWNSrRtRS� West Courtyard Arts Ba spare Room saortt 1 id Room ea V1 4' 2 Basketball Gymnasium K F..C U1 Olrle Bathroom MarPiel Arts N F P S 6�mna�Lt G" £4�to Room y Inner Lobby 5 Hoy's Bathroom Tlonh L -.:N bpi�etne d'.-u�c) �osej4ti oa rW � w 3 Main Lobby Large Malt`-purpose Room p Sncre� Coe! Sreclu.t.r.) � Gr- Use ` au se,.uts uNvE2 4,�.IstDEr2k�totJ Water Sbut Off 'QpXt�Ib CLUB LOGATtOwI EXHIBIT"B" (RULES AND REGULATIONS) 1. Quinonez will use the 225 Building and the Facility(collectively the"Facility")for boxing and training uses and shall not use or permit the Facility to used for any other purpose. Quinonez also agrees that no use consuming abnormally high utility or other service costs, such as computers, shall be permitted at the Facility. 2. Quinonez agrees that except for tenant improvements contemplated in this License,he will make no alterations to the Facility without the written approval of the City. 3. Quinonez will observe all laws and governmental regulations applicable to his use of the Facility. 4. Lessee agrees to take good care of the Premises. 5. Quinonez is responsible for maintaining the security of attendees and parked vehicles at the Facility through its own efforts, within the scope of Quinonez's use of the Facility or any portion thereof. 6. All of Quinonez's refuse and rubbish shall be removed on a regular basis at Quinonez's sole cost and expense. Quinonez shall not place any rubbish or other matter outside any building within the Facility,except in such containers as are authorized from time to time by the City. 7. No radio or television or other similar device audible outside the facility shall be installed without obtaining in each instance the written consent of the City. No aerial shall be erected on the roof,exterior walls or grounds of the Facility without first obtaining in each instance the written consent of the City which consent shall not be unreasonably withheld or delayed. Any aerial so installed without such written consent shall be subject to removal without notice at any time. 8. No loudspeakers,televisions,phonographs,radios or other devices shall be used in a manner so as to be heard or seen outside of the Facility without complying with the provisions of the City's Noise Ordinance. 9. No sirens, outside paging or any type of signalization will be permitted, except approved alarm systems. 10. Quinonez will not allow animals, except seeing-eye dogs, in, about or upon the Facility. 11. Quinonez shall operate in full compliance with United States Amateur Boxing, Inc.rules, standards, and regulations. 772565.1 EXHIBIT "C (SUPERVISORY EMPLOYEES) I , STEVE�j S QUINOQEZ 2 socoNeS LOrO& 772565.1 EXHIBIT "D" (SUPPLEMENTAL QUESTIONS) 772565.1 I [NAME:� /�U a J l eJDI�I� SUPPLEMENTAL QUESTIONNAIRE Pursuant to California Public Resources Code§5164, this form must be completed by all applicants for positions involving supervisory or disciplinary authority over any minor. YES NO 1. Have you ever been convicted of sexual assault or assault with intent to commit mayhem? ❑ 2. Have you ever been convicted or unlawful sexual intercourse with a person under age 18? ❑ e' 3. Have you ever been convicted of rape? ❑ ®/ 4. Have you ever been convicted of the rape of a spouse? ❑ 5. Have you ever been convicted of willful harm or injury to a child? ❑ 6. Have you ever been convicted of child endangerment? ❑ 7. Have you ever been convicted of corporal punishment or injury to a child? ❑ pi 8. Have you ever been convicted of willful infliction of corporal injury to a spouse,former ❑ sf spouse,cohabitant,or mother or father of your child? / 9. Have you ever been convicted of any sexual crime or offense? ❑ �/ 10. Have you ever been convicted of any of the following crimes or an attempt to commit any ❑ gi� of the following crimes? 10.1. Kidnapping? ❑ ` If yes,were you convicted of kidnapping or attempted kidnapping for ransom with ❑ the intent to commit rape,sodomy,lewd or lascivious acts,oral copulation,or forcible acts of sexual penetration? 10.2. Kidnapping for ransom? ❑ If yes,were you convicted of kidnapping for ransom or attempted kidnapping for ❑ ransom with the intent to commit rape,sodomy,lewd or lascivious acts,oral copulation,or forcible acts of sexual penetration? 10.3. Sexual battery? ❑ �/ 10.4. Aiding,abetting or soliciting the rape,rape of a spouse,or forcible acts of ❑ a ` sexual penetration? 10.5. Enticement of an unmarried minor female for purposes of prostitution? ❑ 10.6. Aiding and abetting the enticement of an unmarried minor female for ❑ purposes of prostitution? 10.7. Inducing sexual intercourse with another when the other's consent is ❑ procured by false pretenses with the intent to create fear? 10.8. Pimping of a minor? ❑ 10.9. Pandering of a minor?. ❑ 10.10. Procurement of a child wider 16 years of age for lewd or lascivious acts? ❑ [9/i 10.11. Abduction(taking away)of a person underage 18 for purposes of ❑ e� prostitution? 10.12. Aggravated sexual assault of a child? ❑ at/ 10.13. Incest? YES NO f j 10.14. Sodomy? ❑ 10.15. Lewd or lascivious acts or the solicitation of the same? ❑ 15�/ 10.16. Oral copulation? ❑ 10.17. Continuous sexual abuse of a child? ❑ t� 10.18. Forcible acts of sexual penetration or the solicitation of the same? ❑ LA"� 10.19. Selling,distributing,printing or exhibiting of child pornography? ❑ d / 1020. Sexual exploitation of a child? ❑ 10.21,Employment or use of a minor to perform prohibited acts? ❑ kY i 10.22.Advertising child pornography? ❑ B/l Q 1023. Possession of child pomography? ❑ 10.24. Annoying or molesting a child under 18? ❑ 1025. Solicitation of rape by force or violence,sodomy by.force or 4iolence,or oral ❑ copulation by force or violence? j 10.26. Indecent exposure? ❑ 10.27. Procuring,counseling,or assisting any person to commit indecent exposure? ❑ lYJ 10.28. Contributing to the delinquency of a minor? ❑ Jd , 10.29. Sending harmful material to a minor with the intent to seduce said minor? ❑ �// 11. Have you ever been convicted of armed robbery? ❑ l� 12. Have you ever been convicted of armed carjacking? ❑ 13. Have you ever been convicted of assault or attempted murder of a public official? ❑ H 14. Have you ever been convicted of false imprisonment? ❑ ©/ / 15. Have you ever been convicted of assault? ❑ f� 16. - Have you ever been convicted of battery? - ❑ 17. Have you ever been convicted of murder? ❑ 18. Have you ever been convicted of mayhem? ❑ 19. Have you ever been convicted of a crime that requires you to regis as a sex offender in the ❑ a"/ State of California? - CERT IC ION APPLICANT I hereby certify that all responses herein we an correct, d I understand and agree that any misstatement or omission of material f t m y cause forfeiture on my p f a to oyment by this City. Darer Signature: i i j `EXMBIT X' Page 2 of 2 ENZMENTAL �SUPPLE QUESTI AIRS Pursuant to California Public Resources Code§5164, this form must be completed by all applicants far positions involving supervisory or disciplinary authority over any minor, YES NO I. Have you ever been convicted of sexual assault or assault with intent to commit mayhem? ❑ t/ 2. Have you ever been convicted or unlawful sexual intercourse with a person under age 18? ❑ ¢/ 3. Have you ever been convicted of rape? ❑ ❑/ 4. Have you ever been convicted of the rape of a spouse? ❑ Q/ 5. Have you ever been convicted of willful harm or injury to a child? ❑ g/ 6. Have you ever been convicted of child endangerment? ❑ p� 7. Have you ever been convicted of corporal punishment or ' ? ❑E Y rpo p injury to a child. S/ 8. Have you ever been convicted of willful infliction of corporal injury to a spouse,former ❑ q/ spouse,cohabitant,or mother or father of your child? i 9. Have you ever been convicted of any sexual crime or offense? ❑ r� i I 10. Have you ever been convicted of any of the following crimes or an attempt to commit any ❑ ❑/ of the following crimes? 10.1. Kidnapping? ❑ W/ If yes,were you convicted of kidnapping or attempted kidnapping for ransom with ❑ W the intent to commit rape,sodomy,lewd or lascivious acts,oral copulation,or j forcible acts of sexual penetration? / fit 10.2. Kidnapping for ransom? ❑ V I[ If yes,were you convicted of kidnapping for ransom or attempted kidnapping for ❑ t7l� ransom with the intent to commit rape,sodomy,lewd or lascivious acts,oral copulation,or forcible acts of sexual penetration? 10.3. Sexual battery? ❑ t9� 10.4. Aiding,abetting or soliciting the rape,rape of a spouse,or forcible acts of ❑ ❑/ sexual penetration? 10.5. Enticement of an unmarried minor female for purposes of prostitution? ❑ d 10.6. Aiding and abetting the enticement of an unmarred minor female for ❑ purposes of prostitution? j10.7. Inducing sexual intercourse with another when the other's consent is ❑ j procured by false pretenses with the intent to create fear? f 10.8. Pimping of a minor? ❑ ❑l/ 10.9. Pandering of a minor?. ❑ q/ 10.10. Procurement of a child under 16 years of age for lewd or lascivious acts? ❑ q� 10.11. Abduction(taking away)of a person underage 18 for purposes of ❑ tad prostitution? / 10.12. Aggravated sexual assault of a child? ❑ al- 10.13. Incest? I I YES❑ NO / j 10.14. Sodomy? ❑ La�/ 10.15. Lewd or lascivious acts or the solicitation of the same? - 10.16. Oral copulation? ❑ 631/ 10.17. Continuous sexual abuse of a child? ❑ 0 10.18. Forcible acts of sexual penetration or the solicitation of the same? ❑ f� 10.19. Selling,distributing,printing or exhibiting of child pornography? ❑ 1020. Sexual exploitation of a child? ❑ / 1021.Employment or use of a minor to perform prohibited ads? ❑ 'C3/ 10.22.Advertising child pornography? ❑ / 10.23. Possession of child pornography? ❑ I 1024. Annoying or molesting a child under IS? ❑ 10.25. Solicitation of rape by force or violence,sodomy by,force or violence,or oral ❑ copulation by force or violence? 1026. Indecent exposure? - ❑ 10.27. Procuring,oc mseling,or assisting any person to commit indecent exposure? ❑ 10.28. Contributing to the delinquency of a minor? ❑ / 1029. Sending harmful material to a minor with the intent to seduce said minor? ❑ CW// 11. Have you ever been convicted of armed robbery? ❑ 12. Have you ever been convicted of armed carjacking? ❑ 13. Have you ever been convicted of assault or attempted murder of a public official? ❑ 14. Have you ever been convicted of false imprisonment? ❑ 15. Have you ever been convicted of assault? ❑ J.a' j 16. - Have you ever been convicted of battery? - .. ❑ C+Y// 17. Have you ever been convicted of murder? ❑ 1 18. Have you ever been convicted of mayhem? ❑ 19. Have you ever been convicted of a dime that requires you to register as a sex offender in the ❑ State of California? CERTIFICATION OF APPLICANT I hereby certify that all responses herein are true and correct, d I understand that any misstatement or omission of material fa may.-cause forfeiture on part of all rights to plc Dab 4 29 rg signatwe. i "EX IIBIT A" Page 2 of 2 EXHIBIT "E" WAIVER OF LIABILITY 772565.1 WAIVER AND RELEASE AND ASSUMPTION OF RISK PARENTAL INDEMNIFICATION IN CONSIDERATION OF ME BEING ALLOWED TO PARTICIPATE IN PALM SPRINGS BOXING CLUB ACTIVITIES AND TRAINING, I AGREE: I. 1 understand the nature of Palm Springs Boxing Club activities and my experience and capabilities and believe I am qualified to participate in such activity. I further acknowledge that 1 am aware the activity will be conducted in facilities open to the public during the activity. 1 further agree and warrant that if I believe conditions to be unsafe,I will immediately discontinue further participation in the activity. 2. 1 FULLY UNDERSTAND that(a)Palm Springs Boxing Club activities involve risks and dangers of SERIOUS BODILY INURY,INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH("Risks");(b)these Risks and dangers may be caused by me or the actions or inactions of others participating in the activity,the condition in which the activity takes place,or THE NEGLIGENCE OF THE"RELEASEES"NAMED BELOW;(c)there may be other risks and social and economic losses either known to me or not readily foreseeable at this time;and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES,COSTS,AND DAMAGES incurred as a result of my participation in these activities. 3. I HEREBY RELEASE,DISCHARGE,COVENANT NOT TO SUE,AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS Palm Springs Boxing Club, Steven Quinonez,and their respective agents,employees,volunteers,and other participants,and the City of Palm Springs and its elected officials,officers,employees,volunteers,and agents(each considered one of the"Releasees"herein)from all liability,claims,demands,losses,or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees"or otherwise, including negligent rescue operations and further agree that if, despite this release, I,or anyone on my behalf makes a claim against any of the Releasees named above,I WILL INDEMNIFY,SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES,ATTORNEY FEES,LOSS LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. 4. I CERTIFY THAT 1 HAVE HAD NO INJURIES TO MY HANDS,WHETHER FRACTURES,BROKEN BONES,OR OTHERWISE,WITHIN THE DATE OF THIS FORM AND KNOW OF NO OTHER INJURIES TO THE HEAD SUCH AS CONCUSSION,HEADACES OR FAINTING SPELLS,AND SHOULD I EXPERIENCE ANY OF THESE INJURIES AND CONDTIONS IN THE FUTURE,I WILL IMMEDIATELY NOTIFY THE PERSON IN CHARGE AND CEASE ALL PARTICIPATION IN THE ACTIVITIES. 5. I agree that this agreement may not be modified orally and a waiver of any provision shall not be construed as a modification of any other provision herein or as a consent to any subsequent waiver or modification. Every term and provision of this agreement is intended to be severable. If any one or more of them is found to be unenforceable or invalid,that shall not affect the other terms and provisions,which shall remain binding and enforceable. Signature of Participant Date IF THE PARTICIPANT IS A MINOR(17 YEARS OF AGE OR YOUNGER),A PARENT OR GUARDIAN MUST READ THIS WAIVER AND RELEASE AND SIGN THE CONSENT AND RELEASE OF PARENT OR GUARDIAN ON THE NEXT PAGE 1 CONSENT AND RELEASE OF PARENT OR GUARDIAN I am the parent or legal guardian of the minor child participating in Palm Springs Boxing Club's activities and training.My minor child is fit for participation in United States Amateur Boxing,Inc.activities,and I consent to my child's participation. I HAVE READ AND UNDERSTAND THE WAIVER AND RELEASE OF LIABILITY. In consideration of allowing my child to participate, I consent to it and agree that IT'S TERMS SHALL LIKEWISE BIND ME,MY CHILD, MY HEIRS,LEGAL REPRESENTATIAVES AND ASSIGNEES. I HEREBY RELEASE AND SHALL DEFEND INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM AND ANY LIABILITY that I or my child may allege against the Releasees(include reasonable attorney's fees or costs)as a direct or indirect result of injury to me or my child because of my child's participation in the event,WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or others. I PROMISE NOT TO SUE THE RELEASEES on my behalf or on behalf of my child regarding any claim arising from my child's participation in this United States Amateur Boxing, Inc.activity. Signature of Parent/Legal Guardian Date 2