HomeMy WebLinkAbout04985 - PIRANHA SWIM TEAM PST CITY'S SWIM CENTER POOL COMPETITIVE SWIMMING DOCUMENT TRACKING
Page: 1
Report: Detailed Transactions Detail December 5, 2005
Condition: Document Number a4985,
Document# Description Approval Date Expiration Date Closed Date
A4985 Swim Center 11/01/2004 10/31/2005 10/31/2005
Company Name: Piranha Swim Club
Address: , ,
Group: PARKS & RECREATION
Service: In File
xRef: PARKS & RECREATION
Ins. Status: No Certificate on file.
Document Tracking Items: Due Completed Tracking Amount Amount
Code Item Description Date Date Date Added Paid
to CM for sigs 10/29/2004
" * * * * END OF REPORT * * * * * *
Piranha Swim Team (PST)
Competitive Swimming
AGREEMENT TO USE FACILITIES AGREEMENT#4985
CM signed on 10-29-04
J This Agreement to Use Facilities ("Agreement") is made this 2e/ day of
�cy�L ,200 ` ,by and between the City of Palm Springs("City")and Piranha
Swim Team("PST").
The parties enter into this Agreement on the basis of the following facts and
intentions:
RECITALS
WHEREAS, the City of Palm Springs ("City") and Piranha Swim Team ("PST") are
mutually interested in and concerned with providing quality recreational facilities for the
citizens of Palm Springs; and
WHEREAS,it is recognized that through a cooperative agreement between the City and P ST
the community will be afforded the fulfillment of one of its recreational goals for citizens.
NOW THEREFORE, the City and PST do hereby mutually agree as follows:
1. INTENT OF AGREEMENT
1.1 It is the intent of this Agreement to describe the responsibilities of the City
and PST in their cooperative effort to effectively promote and provide
competitive swimming for an average of one hundred(100)youth and adults.
1.2 It is the intent of this Agreement that the City endorse and recognize PST as
its representative to United States Swimming events and local/regional
invitational swim meets.
1.3 The parties agree that PST may identify the City's Swim Center Pool as its
"home"pool for all swim meets held for or on behalf of PST during the term
of this Agreement.
1.4 It is the intent of this Agreement to solidify a supportive and working
relationship between PST and the City.
1.5 It is the intent of this Agreement that both the City and PST acknowledge and
direct their efforts toward the development of quality swim programs at the
City's Swim Center.
2. AREAS OF RESPONSIBILITY
2.1 Fees and Charges
2.1.1 PST agrees to pay the City for its use of the Swim Center Pool on a
monthly basis. The payments shall be a minimum of $600 per
month, payable in advance on the first of each month and may be
increased pursuant to the rates identified in the City's Comprehensive
Fee Schedule. (If the number of swimmers exceeds what is stated in
Section 1.1 above at anytime during the term of this Agreement,PST
AGREEMENT TO USE FACILITIES
Page 2
shall notify City so that an adjustment to the ponthly fee can be
made.)
2.1.2 For swim meets that involve four or more teams, a $1.25-per-
swimmer charge shall be paid to the City by PST within sixty (60)
days following the meet.
2.2 Pool Use and Scheduling
2.2.1 The City shall make the Swim Center available on a shared, non-
exclusive basis, which does not interfere with the City's other
recreation programs. Notwithstanding the foregoing,it is understood
that PST shall be permitted to utilize the Swim Center in accordance
with the schedule below. This schedule is subject to change with the
approval of the Contract Officer and in accordance with Section
2.2.2. The City has sole discretion to resolve all scheduling conflicts.
The City shall act in a timely manner to resolve all scheduling
conflicts. During high school water sports season, Palm Springs
Unified School District's ("District") schools shall have priority use
of the Swim Center.
PST TYPICAL PRACTICE SCHEDULE
5:00 A.M. to 7:00 a.m. Monday through Friday
3:30 p.m. to 7:30 p.m. Monday through Friday
7:00 a.m. to 10:00 a.m. Saturday
The District's schedule is subject to changes which may affect PST's
use of the Swim Center Pool. During the identified sessions above,
PST may use twelve(12) lanes at the Swim Center Pool. PST agrees
that if City swimmers come to swim on Monday, Wednesday or
Friday between 5:00 p.m. and 6:30 p.m., PST will give up lanes to
accommodate two (2) City swimmers per lane until all are
accommodated [up to the City's designated maximum of three (3)
public swim lanes]. Also,PST will have access to the baby pool area
during regular workouts.At the discretion of City,PST may be given
access to four(4)additional lanes if they are available.The lanes will
be assigned by the City.
The above-listed times apply only to"short course"training. Priority
will be given to the PST for"long course"training.
AGREEMENT TO USE FACILITIES
Page 3
2.2.2 PST must submit its seasonal practice schedule in writing at least
thirty(30) days in advance of the beginning date of the schedule.
2.2.3 PST shall submit a Facility Use Application form at least thirty(30)
days prior to swim meets. The City agrees to make the pool available
if such use does not impact on scheduled City programs or facility
closures. Whenever possible,PST shall try to accommodate joint use
of pool for dual meets that are held at the Swim Center.
2.2.4 The City agrees to rent to PST, at a minimal rate, the Pavilion
kitchen, if available. The Facility Use Application form shall be
submitted by PST at least six (6)months prior to the swim meet.
2.2.5 PST members shall not enter the Swim Center facility for meets or
practices until a coach or designated PST adult representative is on
deck to supervise unless that PST member has paid the public fee to
use the pool.
2.2.6 When the Swim Center is closed for maintenance,the monthly rental
rate will be prorated and adjusted accordingly.
2.3 Coaching Staff
2.3.1 PST shall have complete responsibility for the control and
supervision of its coaching staff.
2.3.2 PST shall be responsible for the control and safety of its members
and guests within the Swim Center.
2.3.3 It is the responsibility of PST to insure that all coaching staff is
currently certified in C.P.R., First Aid and lifeguard training. The
United States Swimming Coach's Certification in First Aid can apply
to this qualification. Proof of such certification must be presented by
PST to the City on a yearly basis. City will not provide lifeguard
services for practice or swim meets.
2.3.4 Any person having supervisory or disciplinary authority over any
minor member of PST is subject to a criminal background screening
as specified in California Public Resources Code Section 5164. Each
PST employee or volunteer having supervisory or disciplinary
authority over any minor must complete the supplemental questions
attached as Exhibit "A" and must concurrently submit to being
fingerprinted by the City. PST must submit a completed copy of
Exhibit"A"and arrange for the fingerprinting of each employee and
volunteer before this Agreement may be executed by the City. The
AGREEMENT TO USE FACILTIES
Page 4
first year that the City performs the background screening for a
particular individual, the screening shall include screening by the
federal government. All subsequent years that the City is required to
perform a background check on that same individual, the screening
need only be performed by the state government.
2.3.5 PST must provide the City with a list of its employees and/or
volunteers who will have supervisory or disciplinary authority over
any minors while at the Swim Center. A true and correct list of such
employees as of the date of execution of this Agreement is attached
hereto as Exhibit`B". Should PST hire a new employee or volunteer
who should be listed on Exhibit `B", PST must notify City of this
fact within one week and PST must concurrently submit a completed
copy of the questionnaire, attached as Exhibit "A" for the new
person.
2.4 Equipment and Storage
2.4.1 City shall provide a storage area on a joint-use basis for PST. PST
shall not hold the City liable for damages for theft of equipment or
material stored on City property.
2.4.2 PST shall install equipment necessary to conduct practice and swim
meets, with the exception of starting blocks. In a like manner, PST
shall remove, in a timely fashion, all equipment that it installs to
conduct practice and swim meets (with the exception of starting
blocks).
2.4.3 PST shall repair or replace, at its expense, damaged equipment if
damage occurred as a result of negligence by PST or its officers,
employees, members or invitees.
2.4.4 The City shall repair or replace damaged equipment, if damaged
other than by PST, at City's expense.
2.4.5 PST shall notify the City of any damaged equipment in need of
repair. Should the City fail to make the requested repairs, PST shall
be held harmless from any claim filed against PST for injury
resulting from said damaged equipment.
2.4.6 If the rental of j oint-use equipment is deemed appropriate, a charge
of$40/day will be imposed. All proceeds will be donated back to the
City for purchase of more j oint-use equipment.
AGREEMENT TO USE FACILITIES
Page 5
2.5 Swim Meets
2.5.1 PST shall clean up all areas in and around the Swim Center that have
been impacted by its use. The City shall coordinate with PST
arrangements for trash pickup and provide equipment/supplies to
maintain the cleanliness of the surrounding area if trash pickup is not
readily available during the time of the swim meet.
2.5.2 The Swim Center shall be closed to the public and all City programs
whenever PST uses the Swim Center for a meet. During this time,
PST accepts full responsibility for the control and safety of the
general public, as well as PST's members and guests. PST shall
provide a first aid kit and sufficient supplies to render first aid service
during the time of the swim meet. The City shall provide access to
back boards during the time of the scheduled swim meet.
2.5.3 PST shall notify City of any dual meets that could allow safe access
of the pool for joint use. The Swim Center staff and PST are jointly
responsible for the control and safety of swimmers as pool use is
shared.
2..5.4 Following the completion of swim meets, PST remains responsible
for the control and safety of its guests and general public until the
Swim Center is cleaned and the admission gates are locked by a PST
representative.
2.6 PST Bylaws
2.6.1 PST must maintain on file two (2) copies of its Articles of
Incorporation, Bylaws, and Rules and Regulations with the City
Clerk's office. Any revisions must be submitted to the Parks and
Recreation Manager prior to action by PST's Board.
3. INSURANCE AND INDEMNIFICATION
3.1 PST shall procure and maintain, at its sole cost and expense, in a form and
content satisfactory to City, during the entire term of this Agreement,
including any extension thereof, the following policies of insurance:
a. Comprehensive General Liabilitv Insurance. A policy of
comprehensive general liability insurance written on aper-occurrence
basis with a combined single limit of$1,000,000.
AGREEMENT TO USE FACILITIES
Page 6
b. Worker's Compensation Insurance. A policy of worker's
compensation insurance in such amount as will fully comply with the
laws of the State of California and that shall indemnify, insure and
provide legal defense for both PST and the City against any loss,
claim or damage arising from any injuries or occupational diseases
occurring to any worker employed by or any person retained by PST
in the course of carrying out the work or services contemplated in this
Agreement.
C. Automotive Insurance. A policy of comprehensive automobile
liability insurance written on a per-occurrence basis in an amount not
less than either(i)bodily injury liability limit of$250,000 per person
and$500,000 per occurrence and property damage liability limits of
$100,000 per occurrence and $250,000 in the aggregate, or (ii)
combined single limit liability of$500,000. Said policy shall include
coverage for owned, non-owned, leased and hired vehicles.
All of the above policies of insurance shall be primary and shall name the
City, its officers, employees and agents as additional insureds. The insurer
shall waive all rights of its subrogation and contribution it may have against
the City, its officers,employees and agents and their respective insurers. All
of said policies of insurance shall provide that said insurance may not be
amended or canceled without providing thirty(30)days prior written notice
by registered mail to the City. In the event any of said policies of insurance
are canceled, PST shall,prior to the cancellation date, submit new evidence
of insurance in conformance with this Section 3.1 to the Contract Officer.
No work or services under this Agreement shall commence until PST has
provided the city with Certificates of Insurance or appropriate insurance
binders evidencing the above insurance coverage and said Certificates of
Insurance or binders are approved by the City.
PST agrees that the provisions of this Section 3.1 shall not be construed as
limiting in any way the extent to which PST may be held responsible for the
payment of damages to any persons or property resulting from PST's
activities or the activities of any person or persons for which PST is
otherwise responsible.
In the event PST subcontracts any portion of the work or services, the
contract between PST and such subcontractor shall require the subcontractor
to maintain the same policies of insurance that PST is required to maintain
pursuant to this Section 3.1.
AGREEMENT TO USE FACILITIES
Page 7
3.2 Indemnification. PST agrees to indemnify the City, its officers, agents and
employees against and will hold and save them and each of them harmless
from, any and all actions, suits, claims, damages to persons or property,
losses, costs, penalties, obligations, errors, omissions or liabilities (herein
"claims or liabilities")that may be asserted or claimed by any persons, firm
or entity arising out of or in connection with the negligent performance of the
work, operations or activities of PST, its agents, employees, subcontractors
or invitees,provided for herein,or arising from the negligent performance of
or failure to perform any term, provision, covenant or condition of this
Agreement, whether or not there is concurrent passive or active negligence
on the part of the city, its officers, agents or employees, but excluding such
claims or liabilities arising from the sole negligence or willful misconduct of
the City, its officers,agents or employees who are directly responsible to the
City and, in connection therewith:
a. PST will defend any action or actions filed in connection with any of
said claims or liabilities and will pay all costs and expenses,
including legal costs and attorneys' fees, incurred in connection
therewith;
b. PST will promptly pay any judgment rendered against the City, its
officers, agents or employees for any claim or liabilities arising out
of or in connection with negligent performance of or failure to
perform such work, operations or activities of PST hereunder; and
PST agrees to save and hold the City, its officers, agents and
employees harmless therefrom;
C. In the event the City, its officers, agents or employees, is made a
party to any action or proceeding filed or prosecuted against PST for
such damages or other claims arising out of or in connection with the
negligent performance of or failure to perform the work,operation or
activities of PST hereunder, PST agrees to pay the City, its officers,
agents or employees, any and all costs and expenses incurred by the
City, its officers, agents or employees, in such action or proceeding,
including, but not limited to, legal costs and attorneys' fees.
3.3 Sufficiency of Insurer or Surety. Insurance or bonds required by the
Agreement shall be satisfactory only if issued by companies qualified to do
business in California rated "A" or better in the most recent edition of Best
Rating Guide, The Key Rating Guide or in the Federal Register, and only if
they are of a financial category Class VII or better,unless such requirements
are waived by the Risk Manager of the City("Risk Manager")due to unique
circumstances. In the event the Risk Manager of the City determines that the
work or services to be performed under this Agreement creates an increased
or decreased risk of loss to the City, PST agrees that the minimum limits of
the insurance policies and the performance bond required by this Section 3
AGREEMENT TO USE FACILITIES
Page 8
may be changed accordingly upon receipt of written notice from the Risk
Manager;provided that PST shall have the right to appeal a determination of
increased coverage by the Risk Manager to the City Council of City within
ten (10) days of receipt of notice from the Risk Manager.
3.4 PST shall provide the City with a properly executed copy of the "Medical
Release and Liability and Waiver and Release" form attached hereto as
Exhibit "C" for each swim team member, swim program participant, swim
competition participant, swim coach, swim official and/or anyone else
associated with PST in any way prior to said person using the City's Swim
Center pool and/or facilities.The"Medical Release and Liability and Waiver
and Release"form shall be executed by the coach,official,participant if over
eighteen(18) years of age, and the participant's parent, natural and/or legal
guardian if the participant is under eighteen (18) years of age.
4. WAIVER OF UTILITY FAILURE
4.1 PST 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 Swim Center.
5. ENFORCEMENT OF AGREEMENT
5.1 California Law. This Agreement shall be construed and interpreted both as
to validity and to performance 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 Agreement shall be instituted in the
Superior Court of the County of Riverside, State of California, or any other
appropriate court in such county,and PST covenants and agrees to submit to
the personal jurisdiction of such court in the event of such action.
5.2 Disputes. In the event of any dispute arising under this Agreement, the
injured party shall notify the injuring party in writing of its contentions by
submitting a claim therefor. The injured party shall continue performing its
obligations hereunder so long as the injuring party commences to cure such
default within ten(10) days of service of such notice and completes the cure
of such default within forty-five (45) days after service of the injured party;
provided that if the default is an immediate danger to the health, safety and
general welfare, such immediate action may be necessary. Compliance with
the provisions of this section shall be a condition precedent to termination of
this Agreement for cause and to any legal action, and such compliance shall
not be a waiver of any party's right to take legal action in the event that the
dispute is not cured,provided that nothing herein shall limit City's or PST's
right to terminate this Agreement without cause pursuant to Section 5.6.
AGREEMENT TO USE FACILITIES
Page 9
5.3 Waiver. No delay or omission in the exercise of any right or remedy by a
non-defaulting party on any default shall impair such right or remedy or be
construed as a waiver. A party's consent to or approval of any act by the
other party requiring the party's consent or approval shall not be deemed 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 other default concerning the same or any
other provision of this Agreement.
5.4 Rights and Remedies are Cumulative. Except with respect to rights and
remedies expressly declared to be exclusive in this Agreement,the rights and
remedies of the parties are cumulative and the exercise by either party of one
or more of such rights or remedies shall not preclude the exercise by it, at the
same or different time, of any other rights or remedies for the same default
or any other default by the other party.
5.5 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
Agreement, to obtain declaratory or injunctive relief, or to obtain any other
remedy consistent with the purpose of this Agreement.
5.6 Termination Prior to Expiration of Term. This section shall govern any
termination of this Agreement. The City reserves the right to terminate this
Agreement at any time, with or without cause, upon sixty(60)days' written
notice to PST, except that where termination is due to the fault of PST, the
period of notice may be such shorter time as may be determined by the
Contract Officer. In addition, PST reserves the right to terminate this
Agreement at any time, with or without cause,upon sixty(60)days' written
notice to City, except that where termination is due to the fault of the City,
the period of notice may be such shorter time as PST may determine.
5.7 Attorneys' Fees. If either party to this Agreement is required to initiate or
defend or made a party to any action or proceeding in any way connected
with this Agreement, the prevailing party in such action or proceeding, in
addition to any other relief which may be granted,whether legal or equitable,
shall be entitled to reasonable attorneys' fees. Attorneys' fees shall include
attorneys' fees on any appeal. 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.
AGREEMENT TO USE FACILITIES
Page 10
6. CITY OFFICERS AND EMPLOYEES: NON-DISCRIMINATION
6.1 Non-liability of City Officers and Employees. No officer or employees of
the City shall be personally liable to PST 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 PST or to its successor or for breach of any obligation of the
terms of this Agreement.
6.2 Conflict of Interest. No officer or employee of the City shall have any
financial interest, direct or indirect, in this Agreement nor shall any such
officer or employee participate in any decision relating to the Agreement 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. PST warrants that it has not paid
or given and will not pay or give any third party any money or other
consideration for obtaining this Agreement.
6.3 Covenant Against Discrimination. PST covenants that,by and for itself, its
heirs, executors, assigns and all persons claiming under or through them,
there shall be no discrimination against or segregation of any person or group
of persons on account of race, color, creed, religion, sex, marital status,
sexual preference,domestic partnership status,national origin or ancestry in
the performance of this Agreement.
7. MISCELLANEOUS PROVISIONS
7.1 Notice. Any notice, demand, request, document, consent, approval or
communication either party desires or is required to give to the other parry
or any other person shall be in writing and either served personally or sent by
pre-paid,first-class mail,in the case of the City,to the Director of Parks and
Recreation, CITY OF PALM SPRINGS, P.O. Box 2743, Palm Springs,
California 92263, and, in the case of PST, to the person at the address
designated on the execution page of this Agreement. Either party may
change its address by notifying the other party of the change of address in
writing. Notice shall be deemed communicated at the time personally
delivered or in seventy-two (72)hours from the time of mailing if mailed as
provided in this section.
7.2 Interpretation. The terms of this Agreement 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 Agreement or any
other rule of construction that might otherwise apply.
AGREEMENT TO USE FACILITIES
Page 11
7.3 Integration; Amendment. It is understood that there are no oral agreements
between the parties hereto affecting this Agreement and this Agreement
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 Agreement. This Agreement may be amended at any
time by the mutual consent of the parties by an instrument in writing.
7.4 Severability. In the event that any one or more of the phrases, sentences,
clauses,paragraphs or sections contained in this Agreement shall be declared
invalid or unenforceable by a valid judgment or decree of court of competent
jurisdiction, such invalidity or unenforceability shall not affect any of the
remaining phrases, sentences, clauses, paragraphs or sections of this
Agreement that are hereby declared as severable and shall be interpreted to
carry out the intent of the parties hereunder unless the invalid provision is so
material that its invalidity deprives either party of the basis benefit of their
bargain or renders this Agreement meaningless.
7.5 Corporate Authority. The persons executing this Agreement on behalf of the
parties hereto warrant that(i) such party is duly organized and existing, (ii)
they are duly authorized to execute and deliver this Agreement on behalf of
said party,(iii)by so executing this Agreement,such party is formally bound
to the provisions of this Agreement,and(iv)the entering into this Agreement
does not violate any provision of any other agreement to which said party is
bound.
8. COORDINATION OF WORK
8.1 Representatives of PST. The following principals of PST are hereby
designated as being the principals and representatives of PST, authorized to
act in its behalf with respect to the work specified herein and make all
decision in connection therewith:
President or Board of Directors' Designee
It is expressly understood that the experience, knowledge, capability and
reputation of the foregoing principals were a substantial inducement for City
to enter into this Agreement. Therefore, the foregoing principals shall be
responsible during the tern of this Agreement for directing all activities of
PST and devoting sufficient time to personally supervise the uses hereunder.
However, if, through the course of this contract,the representatives of PST
change, written notice of such change shall be submitted to the City. A
change in representatives shall not represent a change in the intent or
direction of the contractual agreement between the City and PST.
AGREEMENT TO USE FACILITIES
Page 12
8.2 Contract Officer. The Contract Officer shall be such person as may be
designated by the City Manager of City. It shall be PST's responsibility to
assure that the Contract Officer is kept informed of PST's use of the Swim
Center and shall refer any decisions that must be made by the City to the
Contract Officer. Unless otherwise specified herein,any approval of the City
required hereunder shall need the approval of the Contract Officer. The
Contract Officer shall have authority to sign all documents on behalf of City
required hereunder to carry out the terms of this Agreement.
9. TERM
9.1 Unless earlier terminated in accordance with Section 5.6 of this Agreement,
this Agreement shall continue in full force and effect for a period of one year
beginning November 1, 2004 and ending October 31, 2005.
This Agreement is executed by the duly authorized representative of the City of Palm
Springs and Piranha Swim Team as of the date first written above.
"CITY"
CITY OF PALM SPRINGS
City Manager � rector of Parks acid Recre ion
�f
Attest:
l kP°Wtr: ,C1 C AW.AG E3 ;1�'t Clerk
0511
"PST" �
Piranha S 'm Team
By' Gt�P.fJIG� �h tip/
I %e
By:
Its:
Approved as to Form:
By:
Legal Counsel for Piranha Swim Team
"EXHIBIT A"
Page I of 2
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? ❑ ❑
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? ❑ ❑
8. Have you ever been convicted or willful infliction of corporal injury to a spouse,former ❑ ❑
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 of an attempt to commit any
of the following crimes?
10.1. Kidnapping? ❑ ❑
If yes,were you convicted of kidnapping or attempted kidnapping 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 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 under 16 years of age for lewd or lascivious acts? ❑ ❑
10.11. Abduction(taking away)of a person under age 18 for purposes of prostitution? ❑ ❑
10.12. Aggravated sexual assault of a child? ❑ ❑
10.13. Incest? 0 0
YES NO
10.14. Sodomy? ❑ ❑
10.15. Lewd or lascivious acts or the solicitation of the same? ❑ ❑
10.16. Oral copulation? ❑ ❑
10.17. Continuous sexual abuse of a child? ❑ ❑
10.18. Forcible acts of sexual penetration or the solicitation of the same? ❑ ❑
10.19. Selling,distributing,printing or exhibiting of child pornography? ❑ ❑
10.20. Sexual exploitation of a child? ❑ ❑
10.21. Employment or use of a minor to perform prohibited acts? ❑ ❑
10.22. Advertising child pornography? ❑ ❑
10.23. Possession of child pornography? ❑ ❑
10.24. Annoying or molesting a child under 18? ❑ ❑
10.25. Solicitation of rape by force or violence,sodomy by force or violence,or oral ❑ ❑
copulation by force or violence?
10.26. Indecent exposure? ❑ ❑
10.27. Procuring,counseling, or assisting any person to commit indecent exposure? ❑ ❑
10.28. Contributing to the delinquency of a minor? ❑ ❑
10.29. Sending harmful material to a minor with the intent to seduce said minor? ❑ ❑
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? ❑ ❑
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 register as a sex offender in the ❑ ❑
State of California?
CERTIFICATION OF APPLICANT
I hereby certify that all responses herein are true and correct,and I understand and agree that any misstatement or omission of
material fact may cause forfeiture on my part of all rights to employment by this City.
Date: Signature:
"EXHIBIT A"
Page 2 of 2
"EXHIBIT B"
LIST OF FACILITY USER'S EMPLOYEES AND VOLUNTEERS
WHO HAVE SUPERVISORY OR DISCIPLINARY AUTHORITY
"EXHIBIT B"
Page 1 of I
"EXHIBI I C" - Page 1 of 2
CITY OF PALM SPRINGS RECREATION DIVISION
SWIM CENTER
EMERGENCY CARD/MEDICAL RELEASE/WAIVER AND RELEASE FORM
Participant Name:
Last First MI
Parent/Guardian Name:
Last First MI
Home Address:
City/State/Zip Code:
Phone(day): Phone(evening):
If under 18,the following information is required., Age Date of Birth: /�/
Medical/Health Insurance: Physician's Name/Phone:
EMERGENCY CONTACTS
First and Last Names Relationship to Phone(Day) Phone(Evening) Phone
Participant (Pager/Cellular)
MEDICAL RELEASE
I hereby represent that I am/the participant is physically able to participate in the swim program,event,practice and/or other related activity
and that I have/the participant has no medical condition that may cause any health problem related to my/the participant's involvement
in the swim program,event, practice and/or other related activity at the Palm Springs Swim Center,
WAIVER AND RELEASE FORM
I acknowledge,understand and agree that swimming and/or diving and participation in a swimming program,event,practice and/or other
related activity are extreme tests of a person's physical and mental limits and that my/my child's and/or minor's,for whom I am the natural
and/or legal guardian,(hereinafter the term"child"shall refer to the parent's child and/or a minor under the care of a natural and/or legal
guardian) participation in a swimming program, event, practice and/or other related activity can cause potential death, minor to serious
injuries,disability,property damage and/or loss. I also acknowledge,understand and agree that being in the proximity of swimming pools
creates a danger given wet, slippery and/or other conditions which may result in my/my child's slipping and/or falling. With a full
understanding of the potential risks, I HEREBY ASSUME ALL RISKS associated with my/my child's participation in any and all swim
programs,events, practices,team sports,and other related activities at the Palm Springs Swim Center,including, but not limited to,any
injury, disability, damage, and/or loss related in any way to: swimming; diving; coaching; officiating; strenuous physical activity and/or
exertion;striking and/or being struck by objects and/or persons;slipping and/or falling off/from any and all surfaces and/or all appurtenances
located at the Palm Springs Swim Center;and/or exposure to chemicals,heat,cold and/or humidity.I acknowledge,understand and agree
that said risks may result in injuries that include,but are not limited to:sprain;strain and/ortear of muscles and/or ligaments;fracture and/or
dislocation of joints and/or bones;head and/or facial injuries;spinal cord and/or internal injuries;and/or other injuries and/or disabilities.
I acknowledge,understand and agree that the usual risks,hazards and dangers of incurring damages and/or injuries increase when any
structure and/or device is used in conjunction with swimming,diving,coaching,and/or officiating.I understand that these risk,hazards and
dangers are further increased when other persons,whether or not of the same level of experience of swimming, are present at the same
time and using the same facilities.ALL SUCH RISKS ARE KNOWN AND APPRECIATED BY ME.
I hereby take the following action for myself,my child and my child's executors,administrators,heirs,next of kin,successors and assigns,
and/or anyone else who might claim on my and/or my child's behalf:a)I WAIVE,RELEASE AND DISCHARGE the City of Palm Springs,
its officers,agents,and employees,from any and all duty to me and/or my child from any and all actions,suits,claims,damages to person
or property,losses,costs,penalties,obligations or liabilities(hereinafter"claims or liabilities")which are related in any way to my/my child's
use of the Palm Springs Swim Centerfor any purpose,including,but not limited to,participating in a swim program,practice,events,and/or
other related activity, including all liability for any active or passive negligence by the City of Palm Springs, its officers, agents, or
employees, but excluding such claims or liabilities arising from the sole negligence or willful misconduct of the City of Palm Springs, its
officers,agents,or employees.This release and waiver extends to all claims and liabilities of every kind or nature whatsoever,foreseen
or unforeseen,known or unknown;b)1 AGREE NOT TO SUE the City,its employees,agents,and officers for any of the claims or liabilities
that I have waived,released or discharged herein;and c) I AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS the City of Palm
Springs, its employees, agents, and officers from claims or liabilities that may be asserted or claimed by any person, firm, and/or entity
arising out of or in connection with my/my child's actions during my/my child's use of the Palm Springs Swim Center,whether or not there
is concurrent passive or active negligence on the part of the City,its officers,agents,or employees,but excluding such claims or liabilities
arising from the sole negligence or willful misconduct of the City, its officers, agents, or employees.
i miter ayi :e to grant to me URy or vaim Springs the right to take my photograph and/or video of myself/my child,to use my/my child's
name, likeness,and image,in print,video,and/or electronic medial form,in promotional materials and/or any account or record of my/my
child's participation in any activities at the Palm Springs Swim Center without compensation to me/my child.
1 understand and agree that if I/my child vandalize and/or destroy City property,fees and/or damages will be assessed for which I will be
billed and which I agree to pay forthwith. I/my child understand and agree that I/my child may be denied further admission to the Palm
Springs Swim Center if Ilmy child vandalize and/or destroy any City property.
SIGNATURE(S) REQUIRED
As evidenced by my signature,I certifythat I have read and I understand the foregoing Medical Release and Waiver and Release of Liability
form;and understand and agree that I have given up substantial rights, and affirm that I am eighteen (18)years of age or older.
Printed Name Participant's Signature Date Signed
I AM UNDER THE AGE OF EIGHTEEN (18)YEARS OF AGE, MY PARENT/GUARDIAN HAS READ AND COMPLETED THE
SECTION BELOW. (If applicant is under 18 years of age, a parent or guardian must execute, in addition to the foregoing Waiver and
Release,the following,for and or behalf of the minor.)
The undersigned (parent or guardian name), the parent or natural guardian or legal
guardian of (minor's name) executes the foregoing Medical Release and Waiver and
Release of Liability form for and on behalf of the minor named herein. I hereby bind myself,the minor and all other assigns to the terms
of the Medical Release and Waiver and Release of Liability. I represent that I have legal capacity and authority to act for and on behalf
of the minor named herein, and I agree to indemnify, defend, and hold harmless the City, its employees, agents,and officers from any
claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the
minor in the execution of the Medical Release and Waiver and Release of Liability form whether or not there is concurrent passive or active
negligence on the part of the City,its officers,agents,or employees,but excluding such claims or liabilities arising from the sole negligence
or willful misconduct of the City, its officers,agents,or employees.
Printed Name Parent's/Guardian's Signature Date Signed
"EXHIBIT C"-Page 2 of 2
SK
•'�+ /�T - _ . "CERTHOLDER',COPY
v7T/"'1 I P.O, BOX 8Q7; SAN„F,RANCISCO,CA94142 0807
COMP�14$ATFObJ -
N'S U'FI%A N G'E "'. - .
�U� D CERTIF,LCATE OF,WORKERS' COMPENSATION INSURANCE
:ISSUE DATE 067701-2004: _ - _ ,CROUP: "
- - - - POLICY NUMBER:; ' '1733165-2004
- CERTIFICATE,&, �i'
., . 'CERTTIFICATE. ,XP,IRES 'OQ=01-2005,: -
06-01-2004%06-61-2005.,
CITY OF ,PALM SPRINGS SK JOB:
DEBT OF TACILITI,ES
401 S PA,UILLION 'WAY
PALM SPRINGS CA 92,262
'This is to,ceCtlfy',that we have•.issued a valid Workers' Compensation insurance policy.in a form approved'by'the � _
California Insurance Commissioned'to the, employer,named beI'ovv for�tthe policy period indicated. ; -
:This policy'ls not. subject to-cancellation by,',the Fund_6exept upon 30 days`-advance w�ltten notice-to the empl'pyec,
We vuill,also give'you-�30 days advance-notice should this policy be cancelled prior to,its normal expiration.' -
„ This certifT,cate of insdrance is not an insurance policy*and does not amend;�'exiend or alter the Coverage 'afforded
by 'the, p0lrctes'hstedl herein. Notwiihstandiriii'::any requ6ement,;term, or condition,of any contract or, other document
vvith.respebt tb vvhich .this 6erdficate 'of, insurance"may be issued, or may, p✓3rtain, the' insurance afforded by;the
policies d.,,scrlUed,:herein is subject to all ',the terms, eze(usions' and conditions of such.policies.^ .;
f
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AUTHORIZED REPRESENTATIVE PRESIDENT "
T TIT, TT
11
EMPLOYER',S'LIABILITY L,IMIL-INCLUDING DEFENSE COSTS:, $1 000,000.OO.PER' OCCURRENCE
`ENDORSEMENT Yf0015 ENTITLED ADDITION INSUREp EMPLOYER EFFECTIVE 06-01, 2004 IS ,ATTACf-iED'.TO ANDS
FORMSA;PART OF',„THIS POLICY `"
NAME pF, ADDITIONAL INSOREDu CITY OF, PALM SPRINGS " Sf< -
ENDORSEMENT N2O65�I'ENTITLED�CERTIFICATE HOLDERS' NOTICE EFFECTIVE, 06 01' 2004 IS .'ATTACH$-O 'PTO AND
IT
FORMS ATPART�OF .YNIS POLICY -
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'EMPLOYER',' - IJ
I'T LEGAL NAME
PALM SPRING$ AQUATICS IT
PALM SP
I'.TE RIµGS AQUATICS
11 TAQHU
SU 103
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(Revs=8a1 ., 05/1'vl/2004
„ PRINTED 'A0408
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