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Home My WebLink AboutNUNEZ, JORGE 3BCity of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M -30) Call 647 -6520 if you have any questions. The agreement with Nunez, Jorge A. COTC Office Use Only M4 JHM 161, PM 4: 20 Ci{. c Cte No. , N- 2000 -005A was completed on 6/30/06 and final payment has been made. (List all amendments. Use space below if needed.) 'N- 2000 -188, N- 2001 -105, N- 2002 -096 4N- 2004 -076, N- 2004 - 076 -01j Revised 08 -23 -10 Department: PRCSA Phone /Ext.: 5254 ({ Signature: 1(,,jLD4 Date: 6/12/14 INSURANCE ON FILE WORK MAY PROCEED UNTIL U AN EXPIRES QC CLERK OUNCIL DATE: FIRST AMENDMENT TO CONSULTANT AGREEMENT N- 2002 -096 03 TH S 1 A MENT TO CONSULTANT AGREEMENT, is entered into on 7 d 2 , 2002, by and between Jorge Nunez, a sole proprietor ( "Consulta ') and t City of Santa Ana, a charter city and municipal corporation of the State of California ( "City "). Recitals: A. The parties entered into Agreement N 2001 -105, (hereinafter "said Agreement ") by which Consultant has instructed students in Tae Kwon Do. B. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one year term and to increase the Compensation to cover 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: Scope of Services. Consultant shall perform those services as set forth in Exhibit A to this Amendment to Agreement. 2. 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 Amendment to Agreement shall not exceed $10,000. The total sum to be expended during the term of said Agreement shall not exceed $20,000." 3. The term of said Agreement shall be extended to June 30, 2003. 4. Except as hereby amended, all terms and conditions of said Agreement shall remain in full force and effect. J 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; Laurwsheedy Assistant City Attorney APPROVED AS TO CONTENT: IP" RIBBLE Executive Director of the Parks, Recreation and Community Services Agency CITY OF SANTA ANA c_ DAVID N. REAM City Manager CONSULTANT Exhibit A Scope of Services A. Consultant will prepare and instruct students in the techniques of Tae Kwon Do, teaching classes periodically as follows: City and Consultant shall agree on a class schedule and location. No classes will be held on Labor Day, Thanksgiving weekend, the weeks of Christmas and New Years, Martin Luther King, Jr. Day, Presidents Day or Memorial Day. B. Consultant will provide and be responsible for equipment, records, personnel and clean up of the facilities and materials necessary to insure the effectiveness of said instructions. Class Size Registration A. The minimum number of participants is 10 per class. The maximum number is 45. B. No registration shall be accepted after the second week of classes. C. In the event the minimum number of enrollees is not realized by the second week of classes, the class shall be canceled and Consultant will be under no obligation to provide services, and City will be under no obligation to pay Consultant compensation. Fees A. The fee to participants shall be $30.00 per month per participant. No refunds shall be made to participants, unless class is canceled by the Parks, Recreation and Community Services Agency. B. City shall collect said fees from each participant during the registration period. Consultant shall not collect fees but shall refer participants to the City registration office. City agrees to pay Consultant seventy percent (70 %) of the total fees collected within fifteen (15) working days after completion of the class. City and Consultant agree that City shall retain thirty percent (30 %) of the fees collected. C. Consultant agrees that City representatives shall be entitled to audit Consultant's records to insure compliance with said Agreement. A00Ri7 ' CERTIFICAT6,oF LIABILITY INSURAN( s OP ID R DATE (MMDD 0374688 04 15 /03 03 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. THIS CERTIFICATE IS ISSUED AS KWATTER OF INFORMATION PRODUCER CONFERS NO & Wellness Insurance HOLDER. THIS H S CERTIFIC TIE DOES NOT AMEND, EXTEND OR Agency Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 380 Stevens Ave., First Floor PREMISES(Eaaccurence 5100,000 Solana Beach CA 92075 Phone:800- 395 -8075 Fax:858- 519 -0822 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Specialty National Insuranc 53,000,000 STXD Club 0374688 ��77�� INSURERS: Jorge Nunez 2QV'' Effective: 1/1[03 N INSURER C: GEN'LAGGREGATE LIMIT APPLIES PER: 13692 Newhope t. INSURER D: INSURER E: POLICY JECCT LOC Garden Grove CA 92843 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. rim LTR A A 011M NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE J OCCUR X Nisc.Professional POLICY NUMBER 3XZ126451 -02 PATE MMIDDIYY 01/01/03 DATE MMID 01/01/04 LIMITS EACH OCCURRENCE $100,00000 PREMISES(Eaaccurence 5100,000 MED EXP (Any one person) s2,500 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE 53,000,000 PRODUCTS. COMP /OP AGG $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY JECCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Pr person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Par accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG E $ LIABILITY EACH OCCURRENCE $ AGGREGATE TEXCESSfUMBRELLA CLAIMS MADE E WORKERS COMPENSATION AND _ TO LIMITS ER E.L. EACH ACCIDENT S _ EMPLOYERS' LIABILITY E.L. DISEASE - EA EMPLOYE $ ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS belm OTHER A Sexual Abuse 3XZ126451 -02 100,000 300,000 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT) SPECIAL PROVISIONS APPROVED AS IU FORM *City of Santa Ana, its officers, employees, agents and repreeeatat ves �\ named as additional insured per the attached form CG2010 13/85 O A .LO La heedy Deputy City Attorney rrnu CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SANANAT DATE THEREOF, THE ISSUING INSURER WILLdINNNOWTO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, dM0NgffAdjjjjjWWL The City of Santa Ana* mommom� 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 Jeffrey E. Frick 9) ACORD CORPORATION 1986 ACORD 25 (2001/08) POLICY NUMBER: 3XZ126451 -02 COMMERCIAL GENERAL LIABILITY INSURED: STKD Club 0374688 January 13, 2003 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED -- MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE 1. Designation of Premises (Part Leased to You City of Santa Ana 2. Name of Person or Organization (Additional Insured): City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 (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 II) is amended to include as an insured the person or organization (called 'additional insured:) shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence' which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. APPROVED ,e.. 2011 11 85 ��r Includes copyrighted material of Insurance P6&J &s Efic %T4EC, ik4 04/15/2003 10:43 7145309r -' %✓ TURBAN PLUS �• MMMI-IM1046 11' 1' PAGE 03 Insurance Company /dW kMtoe l Gil �k� (OK This endorsement modifies such insurance as is afforded by the provisions of Policy # 3xF :LZrclating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ( "additional insureds ") with regard to liability and defense of suits arising from the operations and aes performed by ermmb6half of the -named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the flamed 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 separately to each insured against whom claim is made or suit is brought except with respect to 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 cancelled, 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 I �3 Policy # Z Issued to 1 A rr' P this endorsement form as a part of Countersigned by f )W' on ed Representative APPROVED AS 'TO FORM La a ecdy Deputy City Attor w✓ w./ FITNESS AND WELLNESS INSURANCE AGENCY "Formerly Murria & Frick" 380 Stevens Avenue, First Floor, Solana Beach, CA 92075 CA Lic #OD28716 (800) 395 -8075 Fax: (858) 519 -0822 Email: info @fitnessandwellness.com DATE: Al 15 G3 TO: ATTENTION: le y\ //� FAX #: `�W- (VV— tP15IS FROM: SUBJECT: This message contains 4 page(s) including this sheet. If any part of the message is poorly received or missing, please let us know as soon as possible, either by fax or by telephone. COMMENTS: