HomeMy WebLinkAboutCA HISPANIC COMISSION ALCOHOL 2BAGREEMENT TERMINATION
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Please complete this fonn when the attached agreement is no longer in effect.
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Return form to the Sr. Deputy Clerk of the Council (M 34� (41 .647-5218 xi[yti have any
questions.
The agreement with l_alrtl0kjk L CU Z61 RfiC�7 � i�o� -8605 -- / -76
was completed on lie d and final payment has been made.
h ° 2003 "2, i ( 2) CO W Department-
Revised 8 -7 -03
jito Signature:
Date:
City of Santa Ana
Clerk of the Council
(2-b )
N'sJHAD,„L.JPj rIL;
4RK MAY t'POCEE 1 A- 2005 -176
UNTIE_ Iti,W iANCE EXPIRES
l / —1 � —tu5 SECOND AMENDMENT TO AGREEMENT
CLERK CF GoI1NCli
DATE: THIS SECOND AMENDMENT, made and entered into this 19" day of July, 2005, by and between the
AUG 3106 California Hispanic Commission of Alcohol and Drug Abuse ( "Contractor ") and the City of Santa Ana, a charter
city and municipal corporation duly organized and existing under the Constitution and laws of the State of California
("City").
RECITALS
A. The City and Contractor entered into that certain Agreement dated October 1, 2003, hereinafter referred to as
"said Agreement ", to assist youth with substance abuse problems and to find employment. Said Agreement was
previously amended on or around July 19, 2004.
B. The parties hereto now desire to amend the "City's Obligations" amount found in Section 2 and the
"Time Period of Agreement" term found in Section 3 of said Agreement.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and
made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do
hereby agree as follows:
1. The "City's Obligation" section of said Agreement will be amended to read:
..a sum not to exceed,183,125 00."
2. The "Time Period of Agreement" section of said Agreement will be amended to read:
"...shall have been performed by September 30, 2005."
3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full
force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to said Agreement the date
and year first above written.
ATTEST:
Patricia E. Healy
Clerk of the Council
APPROVED AS TO FORM:
By: Lisa E. Storck
Assistant City Attorney
RECD ENDED FOR APPROVAL:
atricia C. Whitaker, Executive Director
ommunity Development Agency
CITY OF SANTA ANA
Z!�2��l
David N. Ream, City Manager
CALIFORNIA HISPANIC
ON ALCONOf DRt
By: James
Title: Exeeu
Director
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Program Name: California Hispanic Commission on Alcohol & Drug Abuse, Inc.
xx OUT -OF- SCHOOL BUDGET
INSCHOOLBUDGET
Line Item Budget
10/01 /2003 to9/30/2005
Separate Gudget if .en ill" bot h
SCInx)t and Uul- If- ,Sehnol `i"�JuIII
Program
Total WIA
MatchiIn Kind
Person nel :, j -.
�f
. �iaSalaries*
MAdministrative
$ 13,1I8
S 84,259
Benefits
$ 4,414
$ 27,854
Other (list)*
Total Personnel
$ 17,532
$ 112,113
$
Operating Expenses:
Rent or user fee*
$ 25,012
S 25,012
Utilities
$ 2,079
$ 2,079
Phones
$ 805
$ 805
Internet fees
$
Parking fees
$
Security
S
Maintenance
$ 942
$ 942
Insurance
$
$ -
$ 1,145
$ 1,145
S 12,040
Equipment*
Rental fees
$
Purchase
$
Vehicle lease charges
$ -
$ 1,750
(Vehicles may not be
purchased)
Office expenses
$ 2,693
$ 2,693
(consumables)
Accounting Services
$ -
$
Legal services
$
$
Auditing services
S -
$
Indirect costs
$ 17,198
$ 17,198
(attach indirect cost
rate plan * *)
Staff training
$ 690
$ 690
Staff travel /mileage
S 1,431
$ 1,431
Customer Training*
$ 1,125
$ 1,125
Support services*
$ 15,965
$ 15,965
Profit (for profits only)
$
$ -
Other (list)*
$ 1,927
S 1,927
Total Operating Expenses
$ 17,198
$ 53,814
$ 71012
$ 13,790
GRAND TOTAL
$ 111,780
$ 71,346
$ 183,125
$ 13,790
(Total Personnel + Total
Operating Expenses)
12- 13 -'04 12:38 FROM- ALL -CAL INSURANCE 9167840158
T -358 P002/007 F -682
DATE ACOR . CERTIFICATE OF LIABILITY INSURANCE 12 /1 M1 2004
12/13/2004
PRODUCER (916) 784 -9070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UPON THE CERTIFICATE
ONLY AS All -Cal Insurance Agency � L THIS CONFE
SOCERT FICAOTE RIGHTS DOES NOT AMEND, EXTEND OR
801 Riverside Avenue $105 j� ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW.
Attn: Beverly A ��''Lt U
Roseville CA 95678- INSURERS AFFORDING COVERAGE NAIC0
INSURED W6URERAN0N PROFITS INS ALLI CE A VI
California Hispanic Commission on Alcohol WsURENR:NORTH AMERICAN ELITE NS.
and Drug Abuse Prevention I ERG:
2101 Capitol Avenue WSURPR D:
Sacramento CA 95816- INSUReae
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN)
REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 L
ROD' P
LIMITS SHOWN MAY HAVE BEEN R
REDUCED BY PAID GLAIME.
POLICT EPPECrlvE p
ppIJOY EXPIRATION L
LIMITS
• X
X G
GENERAL LIABILITY /
2004 -03026 1
/ / /
/ / -
C
,000,
-EACH GOE C
,
MEo ExF (Any one enan) $
$ 5,OC
P RSONAL &ADV INJURY S
S 1,000,0C
X EMPLOYEE RENIFIT6 /
G RALAGORE ATE f
f _2, 000, 0
/ / /
/ % G
ANABELL BATES
CITY OF SANTA ANA
P.O. BOX 1988 M -73
20 CIVIC CENTER PLAZA
INS025(we).05
SHOULD ANY OF THE ABOVE DESCHIBBD POLICIES BB CANCELLED BEFORE TH
EXPIRATION DATE THIREOF• THE ISSUING INSURER MALL X)a% 0)0(.KO( MAI
30 DATE WRITTEN NOTICE TO THE CERTIFICATE HOLDER mmau TO THE LEFT, 10
ELECTRONIC LASER FORMS.
YP AGUHU L V LTPUf(A I IUN l'
Pepe 1
'V_- 13-'04 12.38 FROM- ALL -CAL INSURANCE 9157840158 T -858 P003/007 F -682
ADDITIONAL INSURED INDORSEMENT
Insurance CompanyNnlh �TnS &+o`V G C �$
This endorsement modifies such insurance as is afforded by the provisions of Policy
per- 030 relating to the followir 61:
1. The City of Santa Ana, 20 Civi.�; Center Plaza, Santa Ana, California
92702; its officers, employees, agents and volu-rieers are named as additional insureds
( "additional insureds ") with regard to liability -and defense of suits arising from the
operations and uses performed by or on behalf _-:f the named insured.
2. With respect to claims arising out f the operations and uses performed by
or on behalf of the named insured, 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 ssparsteh; to each insured against whom claim is
made or suit Is brought except with respect tc the company's limits 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 writton
notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
Policy # _= �y�,,c,�/.`- ± =tl
Issued to C1AA.IIrD la
�rNo dO)N A��� �
��c�intersi
i,
i�
this endorsement form as a part of
by thorized presentative 11
RPr'T:TUr;n 17 -10 -' AQ i n. F7 T;Pnm- 41 F,44Z17Z7 Tn- AT T -rhT TMORAT X PARVA0114