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HomeMy WebLinkAboutLE, CHOC 2FAGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. si I AL Return form to the Sr. Deputy Clerk of the Council (M-30). Call a$ if yott lIAVO any questions. ----------------------------------------------------------------- The agreement with was completed on �� f �1 / ®� and final payment has been made. Department: Signature: // Date: 417— 0 Y /. /. Revised 8-7-03 City of Santa Ana Clerk of the Council INSUi'ANCE ON FL: MRK MAY PROCEED IJNTIL INSURANCF EXPIRES CLERK OF COUNCIL GATE: FIRST AMENDMENT TO CONSULTANT AGREEMENT A-2005-149 THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into on June 20, 2005, by and between Choc Le, a sole proprietor ("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 Consultant Agreement A-2004-122, dated June 21, 2004, (hereinafter "said Agreement") by which Consultant has provided martial arts instruction for participants registered through the City's Parks, Recreation and Community Services Agency. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term for an additional one-year period and to increase the compensation to pay for services 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 First Amendment to Consultant Agreement, the parties agree as follows: Section 1, SCOPE OF SERVICES, shall be amended by replacing Exhibit A with Exhibit A-1, attached hereto and incorporated by this reference. 2. Section 2.a., COMPENSATION, shall be deleted in its entirety and replaced with the following language to increase compensation by $1,700.00, annually: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The compensation to be expended under this Agreement shall be increased by $1,700.00 during FY2004-2005 for a total sum of $24,000.00. The total sum to be expended under this Agreement shall not exceed $24,000.00, annually, during the term of this Agreement." 3. Section 3., TERM, shall be amended to extend the termination date from June 30, 2005 to June 30, 2006. 4. Except as herein 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. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: Laura Sheedy Assistant City Attorney APPROVED AS TO CONTENT: GERARDO MOUES' Executive Director € Parks, Recreation and Community Services Agency CITY OF SANTA ANA DAVID N. REAM City Manager CONSULTANT CHOC LE EXHIBIT A-1 SCOPE OF SERVICES 1. Consultant will prepare and instruct students in Tae Kwon Do martial arts techniques. 2. Consultant will confer with City to set the time and location of the classes, including days and hours of class and holidays to be observed. 3. Consultant will provide and be responsible for equipment, records, personnel and clean up of the facilities and materials necessary to ensure the safety and effectiveness of said instruction. CLASS SIZE — REGISTRATION The minimum number or participants is 10 per class, the maximum is 130. No registration will be accepted after the second week of classes. In the event the minimum number of enrollees is not realized by the second week of classes, the class shall be cancelled, Consultant will be under no obligation to provide services and the City will have no obligation to pay Consultant compensation. FEES l . Each participant shall pay a $20.00 class registration fee per monthly session. 2. No refunds will be made to participants after the commencement of a session unless the class is cancelled by the City. 3. City shall collect registration fees from each participant. Consultant shall refer interested students to City for registration. 4. Consultant shall receive seventy percent (70%) of the total fees collected each month. City and Consultant agree that City shall retain thirty percent (30%) of the fees collected as an administration fee. 5. Consultant agrees City is entitled to audit Consultant's records and classes to ensure compliance with this Agreement. 6. Consultant may not waive class participation/registration fees. 7. City shall prepare class rosters and provide a copy to Consultant. Only registered participants may participate in class. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver Alliant Insurance ServicesR-"a-�'v ��2 City o b Santa. Ana P.O.Box 26323 ,j�j•^ pC� 20 Civic Centim P.eaza, M-28 Santa Ana, CA 92799-8323 Iy al f 4- Santa Ana, CA 92701 (949) 660-8163 �^ License No: OC 36861 NAMED INSURED (EVENT HO ): p p ANT �O gMi nTST?Nuc ti.onak-Tae Kwon Do* Choa Le TYPE: 4 FabAi.an0 DATE(S): 1 /01 /05 - 12/31/05 Dtv.fne, CA 92620 LOCATION: Rafaadn Centro *Non Contact This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirements, terms or conditions 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. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 05SEPI0000oi MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY 1, 2006 COMMERCIAL GENERAL LLA131UTY OCCURRENCEFORM DEDUCTIBLE: NONE General Aggregate limit $ 2po0,000 Products & Completed Operations 11000,000 Personal & Advertising Injury 11000,000 Fach Occurrence Limit 11000,000 Fin Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 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 e L "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (event holder). This insurance doss not apply to: Any "occummm" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: Z� � DATE ISSUED: /- - za1)�2-/ ACORD CERTIFICATE OF LIABILITY INSURANCE DAT;ii20/20 ' TM. 06 PRODUCER Prx,.: (800)395-8075 Fax: (858)519,0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # AgencyLiOli OD28716 INSURED INSURER A: Zurich North America CHOC V. LE INSURER e: 4 FABRIANO IRVINE CA 92620.2576 INSURER C: NSURER D. NSURER 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. NSR TR ADDL NSRp TYPE OF INSURANCE POLICYNUMBER POLICY EFFEmrvE ppTE MMN vpucr EzrwprlDM DATE(MMNp LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILIT CLAIMS MADJX OCCUR ST63733.00 12/17/06 12117107 EACH OCCURRENCE $ 1,000,000 OA.AGE TO RENTED PRE. SES(E......—) $ tOO,000 MED. EXP(My one person) $ 2,500 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PEE X POLICY PRO- LOC PRODUCTS-COMPIOP AGG. S 3,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ BODILY accide t) (Per accident) $ PROPERTY DAMAGE Per accitlent $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC AUTO ONLY: AGG $ $ EXCESS I UMBRELLA LABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION$ EACH OCCURRENCE $ AGGREGATE $ 5 $ It WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROYRIETORIPARTNENExECUTNrE OEFICER)MEMMEN CSCLUDED? ay... x..N .. EcuL PRPRwIWlaoxe slow ToevTurrnnD E.L. EACH ACCIDENT 5 E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER :CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 CommunityRedevelopment A PRent Agency Y DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES. 20 Civic Center Plaza (M-25) Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Attention: Jeffrey E. Frick, CEO ACORD 25 (2001108) Certificate # 51125 © ACORD CORPORATION 1988 RECE; ^ 6 2006 DATE SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DEC 2006 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective off! employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12101106 /3 Certificate # 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620.2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) 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 work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "your work' done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701 Y — % 610& — DATE (MWDDNYYY) ACORD TMCERTIFICATE OF LIABILITY INSURANCE 1212012006 . PRODUCER Phone. (800)395-8075 Fax (8M)519-0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # %49 INSURER B: 2620.2576 4-Aovu-145 INSURERC: INSURERD:NCOA r-%j091-/21—613 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED, NOTWITHSTANDING OL ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH 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. POLICY EFFELLNE VOLICY E%FIMTWN LIMITS L TYPE OF INSURANCE POOCV NUMBER DALE NMN oerE Nwop o E GENERAL LIABILITY 5763733.00 12117106 12117107 onM cEEACH o NERRNTECENCE $ X COMMERCIAL GENERAL LIABILIT nREP. lE. eccmrol CLAIMSMAD� OCCUR MED.EXP(Any onepeccon) $ PERSONAL 8 ADV INJURY $ rA 1,000,000 100,000 2,500 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PE PRODUCTS-COMPIOP AGG. S 3,000,000 X POLICY PRO- LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS SCHEDU LED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ Par ac Idenl GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EACH OCCURRENCE $ E%CESS I UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ we sinm-OiNEP WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE 1 $ AkY ROPRIETOMPARTNFR6%FELINE OFFICERMEUSAR E%CLUOELI T.., a..�ns...a.. BPECALP ROV.... -1— EL. DISEASE -POLICY LIMIT Is OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION neural I ennN CERTIFICATE HOLDER' - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Community Redevelopment Agency FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES, 20 Civic Center Plaza (M-25) CA 92701 AUTHORIZED REPRESENTATIVE J y Santa Ana Attention: Jeffrey E. Frick, CEO ©ACORD CORPORATION 1988 ACORD 25 (2001108) Certificate # 51125 R E C E :::.: 6 2006 f SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DDATE EC 2006 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective offh employees, agents, volunteers and representatives are named as additional insureds ("additional Insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12/01/06 Certificate 9 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620-2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) 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 work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "yourwork" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701