HomeMy WebLinkAboutCAMBODIAN FAMILY, THE 5A-2005
A-2004-203-01
INSURANCE ON FILE
WORK MAY PROCEEO
UNTIL INSURANCE EXPIRES
3~g-O(P
CLERK OF COUNCIL
DATE: .OCT 1 9 2005
0' U> il.l THIS FIRST AMENDMENT TO CONSULT ANT AGREEMENT is entered into
. ).) on September 15,2005, by and between The Cambodian Family ("Consultant") and the
(m. . ~a.w,\ City of Santa Ana, a charter city and municipal corporation of the State of California
("City").
FIRST AMENDMENT TO
CONSULTANT AGREEMENT
RECITALS:
A. The parties entered into Agreement #A-2004-203, dated October 4, 2004, (hereinafter
"said Agreement") by which Consultant has operated a Weed and Seed Safe Haven
site.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
extend the term said Agreement for an additional nine months.
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:
I. Section 3, TERM, shall be amended to extend the termination date from September
30, 2005 to June 30, 2006.
2. 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:
CITY uNTA ANA
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DAVIDN. REAM
City Manager
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PATRICIAR HEALY
Clerk of the Council
APPROVED AS TO FORM:
THE CAMBODIAN F AMIL Y
JOSEPH W. FLETCHER
City Attorney
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By: / u /\ a Lj....u ()JI
Laurl{ Sheedy !
Assistant City Attorney
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RIFKA HIRSCH
Executive Director
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ACORQ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
02/08/2006
PRooueER (714)838-1912 FAX (714)838-7568 THIS CERTIFICA TE IS ISSUED AS A MA TTER OF INFORMATION
Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lic #0747473
Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC#
INSURED Cambodian Family ,4-~[)()'f- ~3 INSURER A Philadelphia Ind. Ins. Co.
1111 East Wakeham Avenue 4- ;;I{XJ4-;).03- DI INSURER 8:
Suite E A-;;.ro5 -D18- rx:4> INSURER C
Santa Ana, CA 92705 A-.;>.a:>5- liN INSURER 0
..
INSURER E
THE POLlClES OF INSURANCE LISTED BELQWHAVE 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,
II~~~ ~'1:CJ:r TYPE OF INSURANCE POLlCY NUMBER POL-ICY EFFECTIVE POLlCY EXPIRATION LIMITS
~NERAL LIABILITY PHPK155246 03/09/2006 03/09/2007 ~~_?CC~RRENCE , 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED , 400,000
~ ~ CLAIMS MADE [!] OCCUR MEO EXP (Anyone person) , 5,000
A - PERSONAL & ADV INJURY , 1,000,000
GENERAL AGGREGATE , 3,000,000
~.
GEN'!... AGGREGATE UMIT APr~Y PER PRODUCTS. COMP/OP AGG , 1,000,000
h ,hPRo.
POLICY JECT lOC
AUTOMOBILE LIABILITY PHPK155246 03/09/2006 03/09/2007 COMBINED SINGLE LIMIT
-.. ,
ANY AUTO (Eaacddent) 1,000,000
f.-
All OWNED AUTOS BODilY INJURY
f.- ,
SCHEDULED AUTOS (Per person)
A X
HIRED AUTOS 800ll Y INJURY
X ,
NON-OWNED AUTOS (Per accident}
X $0 Deductible PROPERTY DAMAGE
2. (Peraccidenl) ,
==i~GE LIABILITY AUTO ONLY. EA ACCIDENT ,
ANY AUTO OTHER THAN EA ACC ,
AUTO ONLY AGG ,
3ESS1\lMBRELLA l.IABll.lTY /~ p;i' 1,,- EACH OCCURRENCE ,
OCCUR 0 CLAIMS MADE 0::<./"Lj AGGREGATE ,
.~ ,
~
DEDUCTIBLE ,
RETENTION , ,
WORKERS COMPENSATION AND '1 ~5i~J~'<1 IOJ,t<.
EMPLOYERS' UABILlTY .-
ANY PROPRIETORfPARTNER/EXECUTIVE EL.. EACH ACCIDENT ,
OFFICER/MEMBER EXCLUDED? EL-_ DISEASE - EA EMPLOYE ,
It yes, describe under EL DISEASE - POLICY LIMIT
SPECIAL PROVISIONS below ,
~HER . PHPK155246 03/09/2006 03/09/2007 $1,000,000 Each Claim
A use & Molestatlon $1,000,000 Aggregate
$0 Deductible
DESCRIPTION OF OPERA no~ I LOCATIONS I VEHICLES / EfLUSIONS I'DDED BY ENDON'EMENT I SPe:C~L PROVISJON\
"Except 10 days or non payment 0 prem,um. E"1' oyee D,s onesty 200,000/$2,500 Oed.
Professional Liability $1,000,000 Each Occ/$3,OOO,OOO Aggregate. City of Santa Ana
's named additional insured per contract with named insured. Schedule of vehicles
nd drivers on file. "Non Profit organization"
COVERAGES
The City Of Santa Ana: Its Officers,Employees
Agents, representatives
20 Civic Center Plaza (101-30)
Santa Ana, CA 92705
CANCEL 11 N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPlRA TtON DATE THEREOF, THE ISSUING IN$URER WILL r,)6(X~li MAlI..
30.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
llIXOO(l(~JOOOO(~ltKllMO(lW<Il~X~XX:
XJll VM<<XXXXXXXX
CERTIFICATE HOLDER
ACORD 25 (2001/08) FAX: (714)571-1974
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@ACORDCORPORATION 1988
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AoomONALINSURED ENDORSEMENT
Insurance Company ,_'pHILADELPHIAl~!DEMNITY INSURANCE COMPANY
This at'ldorsemel'lt modlfies such insurance as IS afforded by the provisions of Policy
#PH P f( 1 ~ " j " . ralalit'lg to me folloWing: '
1 ' The Cily of Santa Ana. 20 CMc: Center Plaza. Santa Ana, Catlfomla 92701;
its officers. employees. agents and repre~es are named as additional Insureds
radditJonal insureds.) with reg<;rd to liabUity and defense of sUits arising from the
o!'€r;ljjons and,uses petfooned bv 01 on beha~ 01 the named insured
2 .. Wrthrespect to ~msarislng out 01 theoperatiillns and QsesperfO(l'rted by
or onbetlll\fQf~ flaI'tled insUled,such insuranCElas 15 afforqsr;j by-this poliCy is p(ilnary
at'ldlshot addllioneJ to .oroontributirlg witheny other insUfa.t'lC(il ~by oder \l1e
benefit oHlle addltfQrlalinsured$ Except in the c/!$e of sole negligence or willful
misconduct. .
3,. 1b!slOsuranceappfies separately to e~ii1$t1rt!dagajnst whom. claim .is
madaor $lJitiSl:lr()light~t wllh resp~cl to the CQll1pany'slftrjitsofliabflity . The
inclustonof fSny~or or9S"li<:alionas an Insured shaU nota.ffe<:t arlY rightwt\ieh such
person oror~n would h<we as a claimarnif not so included.
4.. Wl!tt(~to the ad~inllure:ls, thjsinsU~$halJ not be CaocellaO.
or lTI~redUC<<lincoverage olnmits.~afterthirty (8O}dayswri!ten fl()~ nas
beengi1lent<:>U1e..C1ty' \1fSanta )\ria, 20 eMs Clll'lt$rPI9Ul,$antciAn6..Califomia. 92701,.
(Compl.etion of W~ (ollowIng, lnclUQlng countersIgnatUre, jS required to make tills
endorsement ~ectllre.)'
EffecllvQ ,__.03(U2J06
,thiselldorsemef\tfoJ'tn as sparta!
~......._-~.~_....._._---_.
Policy 1/
PHPK155246
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Issued to _THE CAj>1BODIAN :l<'AMILY_.~" '.
Named Insured . ~ ~
CountersIgned by _.. .. .... .... " ..
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