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Home My WebLink AboutROBLES, MONICA DBA HEART CENTERED LEADERSHIP 1ACity of Santa Ana =* r Clerk of the Council AGREEMENT TERMINATION FORM Please complete this farm in its entirety when the attached agreement and amendments (if any) are no longer in effect. Nate: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. 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 No. ` 201 (0_ was completed on�Z-') 3) I6 s -- (List all amendments. Use space below if needed.) Department: r'agreerrentVorrns4orm - agreement termination form_goldenrod.doc COTC Office Use_9nlY czo�(D 5 and final payment has been made. Phone/Ext.: 42. n } Signature: Date: H INSURANCE ON FILE WORK MAY PROCEED & TIL INSURANCE EXPIRES WC Declaration on file. CLERK OF COUNC DATE: o: P1tcs ( Silvia Cuevas yN'F ll HEART C'E_i-NT[:REJ) 1A.,ADE:RSlj1P N-2016-142-01 THIS FiRST.AMENDtvTFNT to the above -referenced agreement is entered into on September 19, 20t 8, by and between 11eart Centered Leadership ("Speaker"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution ruin laws of the State of"C'alifornia ("City"). RLCITAL:S A. The parties entered into an Agreement on September t2, 2018, to provide Entrepreneurship Information and Leadership Workshops to the public for free. The workshops are to be given by Ms. Monica Robles, B, The original term of the Agreement was for services provided from September 10, 2018, through November 5, 2018, and is currently in effect. C. The parties wish to amend the Agreement to include additional date for the workshops, amend the date of payment for the compensation, and replace the prior Scope of Services to reflect this additional event. No additional funds will be added to the Compensation for this Agreement. 'rite Parties therefore agree: 1. Section 1, Event Description: The attached Exhibit A to this First Amendment to the Speaker/perfornier Agreement will replace the previous Exhibit A. 2 . Sectirnt 2, I7ate(s), i, amended to read; "Every Me�nday night front Septcrnbcr 10, 20 i 8 ttrrouglt November 12, 2018." 3. Section S. Co 1pensation,, is amended to read, "$500.00 (payable by check within 30 calendar days of event) upon completion of the November 12, 2018 workshop. The Workshops prior to November 12, 2018 are offered by Speaker without compensation: Speaker-Terformer must provide IRS form W-9 before payment can be made." Except as modified by this First Amendment, all ternrs emd conditions of the Agreement shall remain in full force and effect. (signatures continued on next page] Page 1 OF 2 N-2016-142-01 IN WITNESS WREI(EOF, the parties hereto have executed this First Amendment to the Agreement on the chato and year first written abovo, ATTEST OARIA D. HLJIZAR ,'Clsvk of the Counoil APPROVED AS TO Mal SONIA R. CARVALHO City Attorney BY-Av� I -AURA A. ROSSIN I Senior Assistant City Attorney CITY OF SANTA ANA iWJL GODI1wtEZTI City mBilager SPEAKERIPERFORMER Pip 2 of 2 Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: I lcart Centered Leadership DBA Monica Robles 1439 W. Chapman Ave. Apt. 292 Orange, Ca. 92868 EVENT: Entrepreneurship and 1.,cadcrship workshops for the public. TERM: Mondays, September 10-Nov, 12", 2018 From 5:00 p.m. to 7:00 p.m. September t0 September 17 September 24 October I October 8 October 15 October 22 October 29 November 5 November 12 DESCRIPTION: Monica Robles will be providing the public, entrepreneurship workshops that will provide training and resource opportunities to the participants that are interested in opening up their own business. At the erns of the session, she will also be providing a leadership training workshop, to maximize their effectiveness and their success in their profession. Heart Centered Leadership will provide training tailored to the needs of the participants. Training will: • improve internal and external relationship building skills • verbal communication skills with peers, management, and the public • enhance the level of service given to their clients • help develop proactive behaviors that promote self-confidence, goal setting, and teamwork Monica Robles from I -[cart Centered Leadership will be providing tWQ-11onr sessions beginning Monday, September 10 and terminating Monday, November 12, 2018 from 5:00-7 p.rn. LIMITATIONS: While performing services pursuant to this Agreement, Ms. Robles will not solicit any members of the public for business and will not assist any members of the public with filing out forms containing their personal or business information. The purpose of these workshops is to provide general information to the public about starting a small business, leadership, and professionalism. N-2016-142-01 WORKERS' COMPENSATION DECLARATION I _Monica Robles DBA Heart Centered Leadership Coachinga and Consulting Group hereby affirm under penalty of perjury, the (Nametride) following declaration: I certify on behalf of _Monica Robles DBA Heart Centered coaching and Consulting Group that during the term of my (Consultant/Company Name) contract for —Training_., v� 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: _Aug. 21". 2018 By: __Monica Robles DBA Heart Centered Coaching and Consulting Group Name: Monica Robles DBA Heart Centered Coaching and Consulting Group --- Title: -....--President, Telephone: (480) 518-5557 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE, IS UNLAWFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALIIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO TI`IE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTOR'NEY'S FEES.