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HomeMy WebLinkAboutWeldy, Scott H. 1aCity of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM COTC Office Use Only Y Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with Scott H. Wledy, DVM No. 42003-080 CZAR was completed on 6/30/04 and final payment has been made. (List all amendments. Use space below ff needed.) Department: PRCSA Phone/Ext.: 5254 Signature: � Axe Ca- X jWJ y Date: 5/13/14 Revised 08-2310 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE PIRES CLEIIK,OF O�NCIL' CAtEI (a �ir o 3 AMENDMENT TO CONSULTANT AGREEMENT c5A THIS AMENDMENT TO CONSULTANT AGREEMENT, # A-2003-080, is entered into this --?--day of 2003, by and between Scott H. Weldy, DVM, a sole proprietor ("Consultant") and theCity of Santa Ana, a charter city and municipal corporation of the State of California ("City"). Recitals: A. The parties entered into Agreement #N2003-008, dated February 6, 2003, (hereinafter "said Agreement") by which Consultant has provided veterinary services to the Santa Ana City Zoo. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term of said Agreement and increase compensation to pay for services during the extended term. Wherefore, in consideration of the covenants contained in the Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Consultant Agreement, the parties agree as follows: 1. Section 2.a., COMPENSATION, shall be amended to read as follows: "City agrees to pay, and Consultant agrees to accept as total payment for its services the rates and charges identified in Exhibit A. Maximum amount for reimbursable expenses shall be $2,000.00 per fiscal year. The total sum to be expended for services and reimbursable expenses under this Agreement, shall not exceed $20,000.00 during the term of this Agreement." 2. Section 3, TERM, shall be amended to read as follows: "This Agreement shall commence on February 6, 2003 and terminate on June 30, 2004, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Parks, Recreation and Community Services Agency and the City Attorney." 3. The first paragraph of Section III, COMPENSATION, of Exhibit A shall be amended to read as follows: "CONSULTANT agrees to perform the professional services as set forth herein and CITY agrees to pay CONSULTANT for all such services at the rate of one hundred dollars ($100.00) per hour. Said fees shall be paid not later than 30 days after receipt of proper invoice evidencing work performed, subject to CITY accounting procedures. CITY agrees to pay cost of materials, supplies and laboratory fees incurred for treatment of zoo specimens taken to Serrano Animal & Bird Hospital for treatment. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Consultant Agreement on the date and year first written above. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: Laufa Sheedy Assistant City Attorney K:\WPDOCS\DO02\PO01\00007953.DOC CITY OF SANTA ANA DAVID N. AEAM City Manager Client#: 46200 SERRAANIMI ACORDr. CERTIFICWE OF LIABILITY INS�NCE D/YYYY) 11/20/03 1/20103 PRODUCER THIS CERTIFICAT r3 ISSUED AS A MATTER OF INFORMATION Association Unit ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ABD Insurance & Financial Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 305 Walnut Street Redwood City, CA 94063 A -- 00_j -- P7 INSURERS AFFORDING COVERAGE NAIC # INSURED Serrano Animal & Bird Hospital, Inc. 21771 Lake Forest Drive #111 El Toro, CA 92630 INSURERA: Fireman's Fund Insurance INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HER LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE OATS MM/DDM/ POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY AZC80727616 07/01/03 07/01/04 EACH OCCURRENCE $1 00D 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR PREMGEETO RENTED n $250DDD MED EXP (Any one person) $1 D 000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000 POLICY D PRO- JECT OC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-0W NEO AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE g DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND WZP80914440 07/01/03 07/01/04 WCSTATU- GTH- X I EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A OTHER Professional AZC80727616 07/01/03 07/01/04 $1,000,000 occurrence Liability $2,000,000 aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Workers Comp Information V Voluntary Compensation ** Supplemental Name ** l/ (See Attached Descriptions) City of Santa Ana, Parks, Recreation & Community Services 20 Civic Center Plaza Santa Ana, CA 92701 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL EM1H[*9)t0i_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, REPRESENTATIVE Awrcu zs (2UU1IUa) 1 of 3 #530885 SERRAANIM1 VAB © ACORD CORPORATION 1988 7 C�.rn .- IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 S l2nni/nal o s a we�neee DEWRIPTIONS (Continued fro age 1) Doing Business As: Serrano Animal & Bird Hospital, Inc. City of Santa Ana, Its officers, agents, employees, representatives and volunteers are included as Additional Insured as respects to Operations Perfored by the Named Insured. lau'a �� / AMS 25.312nn1MR1 a of Q oginRRA POLICY NUMBER: AZC80727616 COMMERCIAL GENERAL LIABILITY 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 SCHEDULE Name of Person or Organization: City of Santa Ana, Parks, Recreation & Community Services 20 Civic Center Plaza Santa Ana, CA 92701 (If noentry appears above, information required to complete this endorsement will be shown in the Declarations as applicable o this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you. City of Santa Ana, Its officers, agents, employees, representatives and volunteers are included as Additional Insured as respects to Operations Perfored by the Named Insured. CG 20 26 11 85 - --- ��•�rN aerrano n ana tf Hospital 949 855 1070 p,4 O0t 27 03 01t44p �nta Ana 200 7V537403 p.3 ADDITIONAL INSURED ENDORSEMENT Insurance Company: r( 2 r M/+ O `S F-V U U I14 S &I. This endorsement modLfics such insurance its in afforded by the provisions of policy H 42. C 30 l02 -7(- 14— Rotating to the following: 1. The City of Santa Ann, 20 Civic CCnte:r Plaza, timtta Ana, California 927U7, officers, employees, agents and mprmentativm am,. named as additional insured with regard to )!ability and defense of suite arising front the operations and uses perfunned by on behalf of the named insured, 2. With resircat to claims arising out of the npuralions and uses performed by or on behalf of the named insured, .such losuranceas is'affordetil by this policy is primary and is not to contributing with any other insurance carried by or for the benefit of the additlonal insured. 3. This insurance applies suparawly to each insured orainsl whom claim is made or suit is bought except with respect to the company,!: limits of liability. The inchrsion of any person or orgaoiizttiun as art invurud shall net affect any right which such person or organization would have as it claimant if not sa included. 4. With respect to the, additional insured, thin insurance shall not bo cancelled, or materially rerdueed in coverage or limits except after thirty -',if) days written notice has glvan to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, Completion of the following, including counkmibmature, is required to make this endomurient effective. Effective- 7 — I C 3 , this endorsement farm as part of Policy M A Z C 20 77 4 %( Issued to Se2Rlt1-Ic 4,j,m41- l3i2U I�cSP Sti)C, Namoa Insured Countcrxigncrlby o4/rs/v7