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Home My WebLink AboutHERRERA, MELINA 6- 2018City of Santa Ana Clerk of the Council COTC Office Use Only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all7" AUr 22 P, It: (;u amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF c: ;"N H TA A N A have been satisfied prior to signing the termination form. CLERK O ~ COUNCIL Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with \ YY*eX0,, N-2017-118-01 No. was completed on (Z)3olaot—t and final payment has been made. (List all amendments. Use space below if needed.) Department: P R C S A Phone/Ext.: 143A Signature: 'l1oiNa/ — Date: R l a0 1a0 M Revised: 10-18-16 N-2017-118-01 INSURANCE ON FILE WORK MAY PROCEED 6 >�V INSURANCE EXPIRES CLERK OF COUNCILy 2 2 i— DATE: FIRST AMENDMENT TO RECREATION SERVICES O: PRCS (,0) AGREEMENT WITH MELINA HERRERA Silvia Cuevas THIS FIRST AMENDMENT to the above -referenced agreement is entered into on April 27, 2018 by and between Melina Herrera ("Provider"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement -4N-2017-118,, dated May 11, 2017 ("Agreement"), by which Provider agreed to provide and conduct Care Bear academy classes for children aged 2 % - 5 years of age. The term of the Agreement was from July 1, 2017 through June 30, 2018 and is still in effect. B. The compensation for the Agreement provided a split of the gross revenues received from program participants to pay the Provider seventy percent (70%) of the gross revenues with the City to retain the remaining thirty percent (30%). The total amount of revenue to the Provider shall not exceed $25,000 during the term of the Agreement. C. Prior to the execution of the Agreement, Provider and City were engaged for similar services under Agreement #A-2015-049 dated April 7, 2015, for a term from July 1, 2015 through June 30, 2017. Under the compensation terns of the April 2015 agreement, Provider received 80% of the gross revenues with the City retaining 20% (80/20 split). I D. Due to a clerical error, the compensation terms for the current Agreement were not set forth as an 80/20 split of the revenue. It was the intent of the City to continue the payment split as provided in the prior 2015 agreement. City's intent was manifested in that it continued 80/20 payments to the Provider from July 2017 through January 2018. Payments under the 80/20 split were halted upon discovery of the clerical error in February 201 S. E. The parties now wish to correct the payment split amounts to reflect the 80120 arrangement that was originally intended. City will recognize and pay for invoices for all services rendered during the term of this Agreement under the amended compensation terms below. Provider agrees and understands that the City has paid for said services under the amended terms for the period of July 2017- January 2018. The total not to exceed amount will not be increased. The Parties therefore agree, 1. Section 2, COMPENSATION, is amended to read as follows: In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider eighty percent (80%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed $25,000,00 annually. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider r' N-2017-118-01 shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain twenty percent (20%)"'of all gross revenue received from program participants as an administrative fee. I 2. Except as modified by this First Amendment, all terns and conditions of the Agreement shall retrain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST i Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO, City Attorney $ye LISA TOAs—RCK .L Assistant City Attorney RECOMMENDED FOR APPROVAL: GERARDO MOUET, Executive' Director, Parks, Recreation and Community Services Agency CITY OF SANTA ANA RAUL GODINEZ fI City Manager PROVIDER Melina Hereera EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2018-25 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services N-2017-118-01 20 Civic Center Plaza P. O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Mellott Herrera TYPE: Preschool/Daycare 783 Olympic Ave. _ C 1 -7_ 1 ( DATE(S): 1/05/I8 - 12/31/18 Costa Mesa, CA 92626 LOCATION: Corbin Center *Liquor Liability Yes ❑ No "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2018 EXPIRATION: JANUARY 1, 2019 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal & Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: Medical Payments (Any One Person) 5,000 NIEGL643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,000/$3,000,000 ❑ $2,000,000/$2,000,000 Damage To Property (If purchased) The limits of insurance apply separately to each event Insured by this policy as it a separate policy of insurance has been issued For that event. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy revisions. AUTHORIZED REPRESENTATIVE: CI DATE ISSUED: WORKERS' COMPENSATION DECLARATION I Melina Herrera hereby affirm under penalty of perjury, the (Namel l'itle) following declaration: I certify on behalf of Melina Herrera that during the term of my (Consoltant/Company Name) contract for Recreation Class services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: I By: --- Name: r' Title: 1301.0 - (L&(,-c ; -'t-r C rf -� 7 C � Telephone: `-7) 6t5-:Y - 19 / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.