HomeMy WebLinkAboutRomero, Silvia 1aG zoos
AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no longer in effect
Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647- 5239af ou Ii ave any
questions.
The agreement with 'eZVVUQY2> > J i IV LO.. No. Al-d,004-03q-01
was completed on 1 - 71 �� , ; and final payment has been made.
W- 2004-034 Department: i -4
Signature: I QA)6 t
Date: f 2) It Lf
City of Santa Ana
Revised 8 -7 -03 Clerk of the Council
AI -;l.oo'f- 039-01
INSURANCE ON flU
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
L~-3 I -oif
CLERK OF COUNCil
DATE, I;l.-~O-'>'t
FIRST AMENDMENT TO
CONSULTANT AGREEMENT
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THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into
this 3d"- day of "t:>~~~ , 2004, by and between Silvia Romero
("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the
State of California ("City").
Recitals:
A. The parties entered into Agreement N-2004-039, dated May 3, 2004, (hereinafter
"said Agreement") by which Consultant has provided aerobic classes through the
City's leisure class program.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
renew said Agreement for an additional one-year period.
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 First
Amendment to Consultant Agreement, the parties agree as follows:
1. Section 3, TERM shall be amended to extend the term through December 31, 2005.
2. Except as hereinabove amended, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to
Consultant Agreement on the date and year first written above.
CITY OF SANTA ANA
APPROVED AS TO FORM:
GERARDO MOUE
Executive Director - Parks,
Recreation and Community
Services Agency
J EPH W. FLETCHE
City Attorney
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.:
CER'lIDCATE OF INSURANCE ,
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER: PUBUC ENTITY (ADDmONAL INSURED)
Driver A!lillj1t Insurance Services Cay 0 II Santa. Ana
P. O. Box 28323 20 Civic. Ce.nta Piaza, M-28
Santa Ana, CA 92799-8323 Santa. Ana, CA 92701
(949) 660-8163
License No: DC 36861
NAMED INSURED (EVENT HOIDER): , ' EVENT INFORMATION:
S~v.i.a RomVto N-o),{Jo1-{;3') TYPE: AVJrnhiN.
11045 Me.daLUoYl, #49 N- :~oLA~ 0"'1- 01 DA TE(S): ~/nqln~ - 1?/~1 In~
T lLAtiYl, CA 92180 LOCATION: ~nfgnrln rv~tVh
This is to certify that the policies of insurance Jisted below have been issued to the inswm named above for the policy period
indicated. Notwitbsho...!n,g any ~.........ts. terms or conditions of any contract or other dOCUlDllJll with respect to which this
certificate may be issued or may pertain, the iDsurance afforded by the policies described herein is subject to all the temlS,
exc1nsions and conditions of such policies. LimilB shown may have been reduced by paid claims.
INSURANCE CARlUER: EVllII8Ion Ins\l1"llDCC Company
MASTER POLICY NUMBER: OSSEP1000001
MASTER POLlCY DATES: EFFECTIVE: JANUARY 1,2005 EXPIRATION: JANUARY 1,2006
COMMERCIAL GENERAL UABIUTY OCCUllRENCE FORM DEDUCTIBLE: NONE
Galenl AanPIe Limit $ 2,000.000
Products It C~1eted 0peratl0llS 1,000,000
Personal It Adverlisinllnjury 1.000,000
Each Occmm1ce Limit 1.000,000
Fin> Do..... (Any One Fire) 50,000
ModicaI Pa,ments (Any One Pmon) 5,000
The limits of insunnce apply.......1y 10 each ....t_ by thi. policy u if. __Ie policy ofin........ hill boon illllOd f... thot event
"Who is insured" is amended to include, U 10 insured, the person or orprization shown in this schedule, but culy with 1'CIpCCt 10 liability arising: out of the
own.....ip, moin_... use of the prernis5 used by the namod in...... (....t holder). TIti. in........ doeo not apply 10: Any "occam..:." which takes place
a&rthe event holder ceases tIJ'be a tenant in thatpremi.ses.
OTHER ADDmONAL INSUREDS
,
.
CANr:RI J A nON: Should the above described policy 10 amc:clled before the expiration date thereof. the issuing company win mail 30 days writtel1 notice to the
certificate holder and additional insureds listed.
,.
AurnORIZED REPRESENTATIVE:
~~~
S TO FOIUvl
APPROVED A.
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elf\! "~I
Assistant
DATE1SSUED: Ma4eh 9. 2005