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HomeMy WebLinkAboutLARRY-HERRERA-CABRERA, LKHC CONSULTING (3)City of Santa Ana City Clerk 5� AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. ,_: �cs Note: 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 City Clerk's Office (M-30). Call 647-6520 if you have any questions. The agreement with No. /y -Zo1q — d 54 was completed on ZO 2®i and final payment has been made. (List all amendments. Use space below if needed.) COTC Office Use Only OF THE COUNCLI r 10'23 A49 30 Department Phone/Ext.: GO I c 5z�:)S Signature: Date: � 10�2Z,:3 c;ci LAJI APGE ON FILL-' N-2019-034-01 VV(�? KMM'PROCEE0 !Nil IL INSURANCE EXPIRES "_...-...-_._.__ LEN t k It_ D°,IF MAY 0 1F?Ikgt AMENDMENT TO AGREEMENT WITH LKHC CONSULTING 0 r1%aloAk THIS FIRST AMENDMENT to the above -referenced agreement is entered into on April 29, 2019, by and between Larry Herrera -Cabrera, LKHC Consulting ("Contractor"), 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 No. N-2019-034, dated February 19, 2019, by which Contractor agreed to provide consulting services for the Office of the City Clerk ("Agreement"). B. The Agreement remains in effect through August 19, 2019, and the parties now wish to extend the term and increase the total amount to be expended under the Agreement accordingly. The Parties therefore agree: Section 2.a., Compensation, is amended such that the total sum to be expended under the Agreement shall not exceed $50,000. 2. Section 3, Term, is amended to extend the term of the Agreement through February 29, 2020. 3. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain 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 NORMA MITRE Acting Cleric of the Council APPROVED AS TO FORM SONIA R. CA,RVALHO, City Attorney By: �i �l , -f.w..4, J N M. FUNK Assistant City Attorney CITY OF SANTA ANA STEVEN A. MENDOZA Acting City Manager LKHC CONSULTING Name: Title: RECOMMENDED FOR �� APPROVAL � 4&_ Page 1 of 1 Norma Mitre Acting Clerk of the Council AE� H CERTIFICATE OF LIABILITY INSURANCE GATE 412011YYYV) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemenk(s). PRODUCER C ONAR HIScox Inc. d/b/a/ HISCOX Insurance Agency In CA 520 Madison Avenue $end Floor PHONE (888) 202-3007 AIC No: EMAIL ADDREss: contact@hiscox.com INSURER ($) AFFORDING COVER AGE _. NAIC# NEW York, NY 10022 _ INSURER A: HISCOX Insurance Company Inc T10200 INSURED LKHC Consulting 28D86 Via Del Cerro INSURER B 1 INSURER C : INSURER O i San Juan Capistrano CA 92675 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDLSUBR POLICYNUMBER POLICY EFF MMMdDIYyYYI POLICYEXP (MMiDDNYYY)LIMIT9 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACHOCCURRENCE S 2000,000 t" PREMISES Es occurs ce I_$ 100,004 MED EXP (Any one arson $ 5,000 X Primary & Non Contributory PERSONAL &ADV INJURY $ 2000000 A Y Y UDC-2086768-OGL-18 10120/2018 10120/2019 AGGREGATE LIMIT APPLIES PER: POLICY ❑ jECT LOC GENERAL AGGREGATE $ 2.000,000 r GENL X PRODUCTS - COMPIOPAGG $ S/TGen. Agg, $ OTHER AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT ccde t $ _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED -I SCHEDULED AUTOS AUTOS BODILY INJURY (Per accldent ) $ NON -OWNED H IRED AUTOS _� AUTOS PROPERTYDAMAGE Per acnldant $ $ UMBRELLA LIAOOCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB _J CLAIMSTgAOE OED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANVPROPRIETORIPARTNERIEXEOUTIVE EXCLUDED? NIA OTH• ER EACH T $OFFICERIMEMBER =ACCIDENT MPLOYEE $If (Mandatory in NH) yea, deacrlbe antler— DESCRIPTIONOFOPERATIONSbDIow ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES (ACORD fill, Additional Remade, Schedule, maybe attached If more apace Is required) City of Santa Ana is listed as an Additional Insured. The Hlscox General Llability policy Is primary and any other Insurance maintained by the additional insured is excess and Non. Contributory sabiect to the poiicy terms and condlhans, y7 r'-^ 6^�-f 24R., F City of Santa Ana 20 Civlo Center Plaza (Ni P.O. Box 1088 Santa Ana, CA 92702-19$8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9eAA-9ndd Aral Rrl rfOVM IDA-Finhl All .Ld,a.. ............I ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AM HISCOX Policy Number: Named Insured: Endorsement Number: Endorsement Effective: UDC-2086768-CGL-18 LKI-C Consulting 24 February 13, 2010 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Ilnsured ty of Santa Ana, Its officers ) Civic Center Plaza (M-30) O. Box 1988 anta Ana,CA 92702-1988 SCHEDULE employees, agents, and representatives I Intormation required to complete this Schedule, if not shown above will be shown in the Declarations, Section II -- Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc,, 2004 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02/1312019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polloyQes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endoraement(s), PRODUCER HISOox Inc, d/b/al Hiscox InsUranCe Agency In CA 520 Madison Avenue 32nd Floor C MEACT PHONE ($$$) 202-3007 (F(C pl: `N E.mAIL ADD Ess: contact@hlscox.com �T ..._._....... INSURER(S) AFFORDING COVERAGE NAIC,y_ New York, NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 INSURED LKFIC Consulting INeuftr•.R e 28080 Me Del Cerro INeURERC: INSURER D: San Juan Capistrano CA 92675 NSURERE: INSURER P COVERAGES CERTIFICATE NUMBER' REVISION nIUMSER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR UIR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM QI POLICY EXP DONYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ O R TEp PREMISES Ea occulnnc $ MEN EXP(Any one person) S PERSONAL &ADV INJURY $ IES PER: AGGREGATE LIMIT AP —PLIES LOC POLICY PRO- a ECT a GENERAL AGGREGATE $ GEN'L PRODUCTS COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED S INGLELIMIT Ea awltlent $ BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED . AUTOS BODILY INJURY (Per accident) 5 HIRED AUTOS AAUTOSUT SWNED PROPERTY DAMAGE _ c Iden S $ UMBRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE QED RETENTION.$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECU I VE OFFICERIMEMBER EXCLUDED? NIA PER OTH- STATUTE E EL EACH ACCIDENT $ E.L, DISEASE - EA EMPLOYEE $ (Mandatory I., NH) If yes, describe under EL. DISEASE - POLICV LIMIT $ DESCRIPTION OF OPERATIONS below A Professional Liability UDC-2080768-EO-18 10/20/201$ 10/20/2010 Each Claim: $ 1,000,000 Aggregate: $'1,c00,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is mr,rdAredd)) CERfIFIC/AtE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZCD REPRESENTATIVE / @ 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 2512014101) The ACORD name and logo are registered marks of ACORD