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Home My WebLink AboutLE, CHOC 2CCity of Santa Ari C 20p9 Clerk of the Coun, AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effec3I. Return form to the Clerk of the Council Office (M-30). Call 647-5237 if you have any questions. The agreement with a No. /T ' 4" Jwas completed on f p��% J(D3 and final payment has been made. Department: �vrVV �C1� Phone/Eat.: Signature: !1 � J / Date: Revised 07-23-07 A _ J w � —I City of Santa Ana Clerk of the Council AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in of ec 1. _ 2 Ali Q' 28 Return form to the Clerk of the Council Office (M-30). Call 647-5237 if you have any questions. ---------------------------------- ---------------- The agreement with } No. was completed on . and final payment has been made. 2 < 14t;t Z.� `N Revised 07-23-07 Department Phone/Ext.: Signature: Date: ��— INSURANCE ON FILE • • WORK MAY PROCEED A-2003-094 UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: lO— 9-C,3 THIRD AMENDMENT TO CONSULTANT AGREEMENT THIS THIRD AMENDMENT TO CONSULTANT AGREEMENT is entered into on May 19, 2003 by and between Choc Le ("Consultant') 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. City and Consultant entered into Consultant Agreement N-2000-186, dated December 1, 2000 (hereinafter "said Agreement') by which Consultant has instructed students in Karate. B. The parties amended said Agreement to extend the term thereof by Amendment N- 2001-108, dated June 19, 2001 and again by Amendment N 2002-097. C. In accordance with the terms and conditions of said Agreement, the parties wish to amend said Agreement to increase compensation to pay for additional services performed because of increased enrollment in the classes during the extended term. Wherefore, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this 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. The total sum to be expended under this Agreement shall be increased by $2,500.00 for a total not to exceed amount of $12,500.00 during the term from July 1, 2002 through June 30, 2003." IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Consultant Agreement on the date and year first written above. ATTEST: PATRIM E. HEALY Clerk of the Council APPROVED AS TO FORM: SEPH W.FLETC R City Attorney CITY OF SANTA ANA I va,� a��IW6 DAVID N. REAM City Manager CONSULTANT if " V� CHOC LE ACORO • CERTIFICATE Fitness & wellness Insurance Agency 380 Stevens Ave., First Floor Solana Beach CA 92075 Phone:800-395-8075 Fax:858-519-0822 Choc V.Le #0375057 8ff: 01-06-03 4 Fabriano Irvine CA 92620 LIABILITY INSURANC ALTER THE COVERAGE INSURERS AFFORDING COVERAGE INSURER B: INSURER C: OPID R oATEIMMIDDIYYYY) 0375057 03/28/03 A MATTER OF INFORMATION UPON THE CERTIFICATE S NOT AMEND, EXTEND OR :D BY THE POLICIES BELOW. NAIC # nal Insuranc 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. -TR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIO DATE (MWDDfyyl LIMITS GENERAL LIABILITY EACH OCCURRENCE f1,000,000 TAN -ro-FA PREMISES Faaccurence) $100,000 X X COMMERCIAL GENERAL LIABILITY 3XZ126451-02 01/06/03 01/06/04 CLAIMS MADE D OCCUR MED EXP (Anyone Person) S 2 , 500 PERSONAL SADVINJURY $1,000,000 A X Misc.Professional GENERAL AGGREGATE $3, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG $1,000,000 POLICY 7 PRO-JECT LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per Person) f ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Peraccident) f GARAGE LIABILITY AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ f $ DEDUCTIBLE f RETENTION $ WORKERS COMPlNSATIGN AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTNE OFFICER/MEMBER EXCLUDED? TORV LIMBS ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE S If s, describe under SPECIAL PROVISIONS belay E.L. DISEASE • POLICY LIMB S OTHER A Sexual Abuse 3XZ126451-02 100,000 300,000 )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS APPROVED FORM AS TO It is understood and agreed City of Santa Ana, its officersagents, V 1�lYl employees, representatives, and volunteers are added as addition insuered per the attached form CG201011/85 La) U Dicedy I)g1titY City Attorney CERTIFICATE HOLDER CANCELLATION SANANAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, 30 DAYS WRITTEN City of Santa Ana Parka and NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Recreation, & Community Services Agency P.o. Box 1988 M-23 Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE E This Endorsement changes the Commercial Liability Policy. PLEASE read it carefully. This endorsement, effective on 01/06/02 at Standard time shown in the Policy Declarations, forms a part of Policy Number 3XZ126451-01 issued to Choc V. Le #0375057 by Hull & Company (Specialty Nat). Endorsement Number 001 This endorsement modifies insurance provided for under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ADDITIONAL INSURED - BLANKET FORM WHO IS AN INSURED (Section II) is amended to include as an insured the person(s) or organization(s) shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. Name of Person or Organization City of Santa Ana Parks & Recreation Dept PO Boa 1988 Santa Ana, CA 92702 All certificates of insurance holders you have agreed to include as an insured prior to an "occurrence" or offense. (8-97) APPROVED AS TO FORM Laur, heady Ddpury City At rney 01/10/03 15:23 Z004 ADDITIONAL INSURED ENDORSEMENT Insurance Company I V j" j This endorsement modifies such insurance as is afforded by the provisions of Policy # ?>YZ I - Q Zrelating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701: its officers, employees, agents and volunteers are named as additional insureds ("additional insureds') with regard to liability and defense of suits arising from the - - --operations-and uses perfomied by -or on bebalf of the named insu — 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named "inured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company s Wits of liability. The Inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective `Zb this endorsement form as a part of Policy# Issued to Countersigned by ',"PRO` 1-0 AS 'FO FORM I aura Sheedy Ut''i!(Y City Attorney