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HomeMy WebLinkAboutTORRES, MARTIN (2)0�„ City of Santa Ana '`� Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement a amendments (if any) are no longer in effect. 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 Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. OF THE COILIMIL 9'22 Am11:1H The agreement with Ma - ` ri o we'S N-2019-091-01 No. was completed on /P gib and final payment has been made. (List all amendments. Use space below if needed.) �r� Department: (' FCS--)nv— Phone/Ext.: Signature: Date:���- Revised: 10-18-16 IN51Jit°" Et `ud(l�1KM11r ir,l;�l? N-2019-091-01 t la =`, „t,�NCL i�XpiilbS �) FIRST AMENDMENT TO ACREEMC, NT WITH MARTIN TORRE, 8 TO PROVIDE KARATE DO 1GAI CLASSES THIS FIRST AMENDMENT to the above -referenced agreement is entered into on June 20, 20I9, by and between Martin Torres ("Provider"), and the City of Santa Ana, a chatter 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-2019.091 ("Agreement") dated April 26, 2019, to provide Karate Do Mal classes for the City's recreation class program. The Agreement is scheduled to run from July 1, 2019 until June 30, 2020. B. The patties wish to remove and replace the scope of work initially provided in the Agreement to add an additional class and revised grading times and information regarding the material fee. No other changes to the Agreement are contemplated in this First Amendment. The Parties therefore agree: 1. Section 1, Scope of Work, is hereby amended to remove and replace Exhibit A to the Agreement with Exhibit A-1, attached hereto and incorporated by reference. 2. 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, iT;Tl IT , a„ CITY OF SANTA ANA NORMA MITRE -- . I K TINE RI GEE Acting Clerk of the Council City Manager APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By; LAURA A. ROSSINI Senior Assistant City Attorney F" itive Director, _ Recreation and Community Services Agency PROVIDER ARTiN TORRES Page 1 of I Exhibit A-1 SCOPE OF SERVICES A. Provider shall conduct Karate Do Kiai classes for ages 4 yrs. old and up. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. KARATE DO KIAI Japanese style martial arts class to improve one's self-discipline, physical and mental attributes, to help children become better students, and to encourage productive activities. This class teaches respect for one another and helps children become independent on their responsibilities, and decisions. Program for young children and their parents call "Baby Karate" which encourages parents to be involved with their children in the class. Classes are taught in Spanish. INSTRUCTOR: Martin Torres, Class Fee: $50.00/month for 4 classes LOCATION: Jerome Center, 726 S Center St., Santa Ana, (714) 647-6559 • Karate Do Kiai classes will consist of monthly sessions, held 4 days per week, 1 hour per day. (4-7yrs) Monday & Wednesday 6:00 P.M. - 7:00 P.M. • Karate Do Kiai classes will consist of monthly sessions, held 4 days per week, 1 hour per day. (7-12yrs) Monday & Wednesday 7:00 P.M. - 8:00 P.M • Karate Do Kiai classes will consist of monthly sessions, held 4 days per week, 1 hour per day. (12 yrs. & Up) Monday & Wednesday 8:00 P.M. - 9:00 P.M. • Karate Do Kiai classes will consist of monthly sessions, held 4 days per week, 1 hour per day. (All Ages) Tuesday & Thursday 7:00 P.M. - 8:00 P.M. • Student Grading are performed three times a year in the month of April, August and December. A material fee of $35-$50 is collected by instructor and payable by parent. • Student Grading Tournaments are performed three times a year. A material fee of $35.00 is collected by instructor and payable by parent. C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of instruction. D. Provider will allow one week in April, August and December for student grading instead of class time. CLASS SIZE A. Each class must have a minimum of 10 paid students and no more than 45 students. B. No registration will be accepted after the second meeting of classes. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2019-13 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Atliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. 0. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT BOLDER): EVENT INFORMATION: Martin Torres TYPE: Martial Arts 12692 Ranchero Way DATE(S): 01101/2019-12/31/2019 Garden Grove, CA 928443 LOCATION: Jerome 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 MASTE R POLICY NUMBER: SEP41028 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2019 EXPIRATION: JANUARY 1, 2020 COMMERCIAL GENERAL LIABILITY OCCURRBNCEFORM 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 Ranted To You (Any One Premises) 1001000 Certificate Of Insurance: Medical Payments (Any One Perron) 5,000 MEOL643 Liquor. Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,000/$3,000,000 ❑ $2,000,000/$2,000,000 Damage To Property (If purchased) The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS CANCELLATION: Should tho above described policy be cancelled before the expimumn date thereof, notice will be delivered in accordance with the policy revisions. AUTHORIZED REPRESENTATIVE: DATE ISSIJED: January 3, 2019, Risk Management, FRV ,KORXIZS° QQM_J1j;NSAI' NDE�QLARNFJON I _Martin Torreshereby affirm under penalty of perjury, the (Namefrltle) following declaration I certify on behalf of Martin Torres that during the term of my (Cm�anitantlC.mnpa�ty Namaj contract for —Leisure Class Instruction_ services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subjcct to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: ©i - By: Name; Mmtin Torres Title: _Leiswe t U/ Class Instructto�r(� �7 _ Telephone: _ WARNING; FAILURE TO SECURE WORIORS' COMPENSATION C.OVERAOE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($I00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY' S FEES, Mr, Martin Torres 12692 Ranchero Way Garden Grove, CA 926443 June 25, 2019 City of Santa Ana Risk Management Division 20 Civic Center Plaza, Santa Ana, CA 92702 Re: Auto Insurance Requirement Release of Liability, Dear City of Santa Ana Risk Management Division: 1, Martin Torres, Recreation Instructor, hereby release the City of Automobile Liability, I do not use/drive any vehicle during the course and scope of my course/instruction class, During the term July 1, 2019 through June 30, 2020, Agreement N-2019-091, I will be teaching Karate Do Kiai Japanese style Classes at Sol -011ie Center located at: 726 S. Center St„ Santa Ana, CA, Sincerely, Martin Torres, Recreation- ctor ��,1 plvia�pn a�1�tn �OD (�LS�