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HomeMy WebLinkAboutSUAREZ, RAYMUNDO 2aCity of Santa Ana Clerk of the Council AGREEMENT TERMINAYION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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 Suarez, Raymundo G 200b COTC Office Use Only No N -2005 -101 was completed on 6/30/06 and final payment has been made. (List all amendments. Use space below if needed.) N- 2005 - 101-01, N- 2005 - 101 -02, N- 2005 - 101 -03, Department: PRCSA N- 2005 - 101 -04, N- 2005 - 101 -05, N- 2005 -101 -006 N- 2005 -101 -007 Phone /Ext.: 5254 Signature: a CiAJ lfSl 21 Date: 6/16/14 Revised 08 -23 -10 N- 2005 - 101 -01 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES G- /5-% CLERK OF COUNCIL FIRST AMENDMENT TO AGREEMENT' DAIL A- 15-04 CarhZFcm1*b THIS FIRST AMENDMENT TO AGREEMENT is entered into on May 15, 2006, by and between Raymundo Suarez ( "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 qN- 2005 -101, dated June 1, 2005, (hereinafter "said Agreement ") by which Consultant has instructed self defense classes. B. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one year period. W1IEREFORE, 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 Agreement, the parties agree as follows: I. Section 1, SCOPE OF SERVICES, is shall be amended by amending Exhibit A to add a final paragraph, which shall read, in full, as follows: "Il' Consultant utilizes the services of other instructors in the performance of Consultant's agreement, those other instructors must be covered by Consultant's General Liability Insurance, must be 2l years of age or older and must have obtained an instructor rating. Black belt rated students may warn up beginning students, however Consultant must be in the room at all times. The City may bump any class as the City deems necessary. The Consultant will be given a date to make -up the bumped class." 2. Section 3, TERM, shall be amended to extend the termination date to June 30. 2007. H IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. CITY OF SANTA ANA ATTEST: / PATRICIA E. HEAL DAVID N. R .AM Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney CONSULTANT I,7nYa Sheerly Assistant City Attorney ItAYMUNDOSUAREZ Owner RECOMMENDED FOR APPROVAL: GE.RARDO MOU T Executive Directo Parks, Recreation and Community Services Agency ACORD CERTIFICATE OF TM LIABILITY INSURANCE DATOB/2M312005 Y1 PRODUCER Phone (800)395.8075 FAX (858)5100812 FITNESS AND WELLNESS INSURANCE AGENCY THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 SOLANA BEACH CA 92075 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED RAYMUNDO SUAREZ 610 S TOWNSEND ST SANTA ANA CA 92703 COVERAGES INSURERS AFFORDING COVERAGE I NAIC # TO 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. rtdR AOPL TYPEOFINSURANCE POLICY NUMBER POLICY6FF6CTIV6 POLICY EXPIRATION LIMITS 1R INSR Jeffrey E. Frick, CEO DATE MRe DM' DAYS MMIODMI GENERAL LIABILITY EOLD012327 -01 06/15105 06/15/06 EACH OCCURRENCE $ 1,000,000 X OAMAGE TO RENTED $ 100,000 COMMERCIAL GENERAL LIABLItY CLAIMS MADE OCCUR PREMISES L---) NED. EXP(Anyone person) �i$ 2,500 PERSONAL S ADV INJURY '$ 1,000,000 A GENERALAGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS- COMP /OP AGG. 5 3,000,000 P I X POLICY JEDRO T TOO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO F. —S—L $ ALL OWNED AUTOS BODILY INJURY (Pe, person) SCHFDUI FD AUTOS — �$ HIRED AUTOS - -$ NWILY INJURY DUN OWNED AUTOS (Pe, accitleni) -- - - -- 'PROPERTY DAMAGE (Pareccidenp GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHANA ACC $ ANY AUTO AUTOONLY AGO $ EXCESS I UMBRELLA LIABILITY FACT I OCCURRENCE $ OCCUR EJ CLAIMS MADE AGGREGATE 8 $ I DEDUCIBLE $ cc;; RETENTION $ APPROVED D - n S TO FOR $ 'WORKERS COMPENSATION AND siAV ._ER EMPLOYERS LIABILITY -TORY LIMITS. �---' ANY aRTNER,EXE6umE i T /_ � E L EACH AGO 8 OFF IC ERRaEMBER EXCLUDED' V �IIDTa 5t Yf Sh OGdy FI DISEASE FN EMPLOYEE $ EL DISEASE POLICY LIMIT $ Sn4AL PRO Some SPECIAL PROYiSION6 Eabw '', r \iJIR L'n 1,. L,i( A[tOCp C' }. OTHER'. DESCRIPTION OF OPERATIONS /LOCATIONS(VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 82701. ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM THE OPERATIONS AND USSES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) Certificate # 23013 © ACORD CORPORATION 1998 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO CITY OF SANTA ANA DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IPS 20 CIVIC CENTER PLAZA AGENTS OR REPRESENTATIVES. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE Attention: Jeffrey E. Frick, CEO ACORD 25 (2001/08) Certificate # 23013 © ACORD CORPORATION 1998 ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company ZatctA WtkjC W INS. Co. This endorsement modifies such insurance as is afforded by the provisions of Policy # CpLR 193'Z -7 —OI relating to the following: 1. The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective 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 uses performed by or on behalf of the named insured. 2. With respect to claims arising out of 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 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 Community Redevelopment Agency of the City of Santa Ana, 20 Civic Center Plaza (M -25), Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective .TUNE 15) 9001; — (%LVG , this endorsement form as a part of Policy # irl-9g 9"D'1 -DI Issued to 12A* /NI1M OD Named Insured Countersigned by �( PP v1t , 7 AS TO FORP.t Au11111 Rqrrescatative �F�ars Stitt Sl;ced�� POLICY NUMBER: EOL9D12327 -01 COMMERCIAL GENERAL LIABILITY 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 SCHEDULE Name of Person or Organization; CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 (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 shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by or for you 6S 10 FORAI CG 20 10 11 85 Copyright. Insurance Services Office, Inc., 1984 Certificate # 23013 ,t/- 2DV5- >D1 -D2- A CORD DATE (MMIDDIYYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 07119/2007 PRODUCER Phn : (S00) 3V eD7 Fw.. (a5B) 510-M2 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INFORMATION 360 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 1 HOMER, THIS rRRTIFICATF 1309n INSURERS AFFORDING COVERAGE INSURED RAYMUNDO SUAREZ 610 S TOWNSEND STREET SANTA ANA CA 92703 NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED FOR THE POOCYPERIOD INDICATED. NOTWITHSTANDING ANY REO(AREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTH{ THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUB.ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LTR TYPEOFNSURANCE POLICYNUMBER MM ,. . _ Representatives and Vosu148017 4 20 Civic Centar Plaza / - "- LIMITS jA cf+ • Je" ffre� Frick, CEO GENERAL LIABILITY X cGMMEac+aLCB=NEw.uaaL CLAIMS MADE[j] OCCUR PHPK215316 ' O6H5107 06116106 EACH CE $ 1,000,0 ;M) $ L®.EXP(A9 pmw) _ _100.000 s 2,600 PERSONAL& ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENLAGGREGATELN)TAPPLESP X POLICY n PRO- LOC PRODUCTS�COMPIOP AGG. S 3,000,000 AUTOMOBILE LIABILITY MY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTO$ NON-OVMEO AUTOS COMBINED SINGLE LIMIT (EA&cddsOO $ SODRYPUURY VPWPK9" $ 80DLY INJURY (Pwwodd -% $ PROPERTY DM1AGE $ — GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ DINER 7HAN EAACC AUTOONLY: AGG $ $ EXCESS f UMBRELLA LIABILITY OCCUR FI CLAIMS MADE DEDUCTIBLE RETENTIONS EACHOGCURRENCE $ AGGREGATE $ Is $ $ WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY ANYNlAP9ATdlflARINERRRlCUIYE a1E W L PNAlY810NA ANOrr I TORYNAMRB uT1ER E.LEACHACCIDENT $ F dSF.ABE -EA EMPLOYEE $ EL OISEASE- POLICY LIMIT $ OTHER: DESCRIPTION OF OPERA7TONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS it is understood and agreed that the following entlty Is added as an additional Insured but orgy as respects the operations of the named Insu except that liability resulting from the additional Insureds sole negligence. Policy is Primary and Non - Contributory. ACORD 25 (2001108) Certificate # 59631 ®AGORLI cOKPORAI ION laaa t _ ,• 1 T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED eEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 City of Santa Aria: y I t- Ifs Agents, OffiCBrs+r �./"( �. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NOOBLIGAMON OR UABILRY OFANY KIND UPON THE INSURER. ITS AGENTS OR RFPRESENTATNES. ,. . _ Representatives and Vosu148017 4 20 Civic Centar Plaza / - "- AUTHORIZED REPRESENTATIVE / �. Santa Ana, CA 92701 .r +.. Attention: ✓ cf+ • Je" ffre� Frick, CEO ACORD 25 (2001108) Certificate # 59631 ®AGORLI cOKPORAI ION laaa t _ ,• 1 T POLICY NUMBER: (PHPK 2153161 COMMERCIAL GENERAL LIABILITY 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.Primary and Non- Contributory 2. City of Santa Ana It's Agents, Officers, Representatives and Volunteers 20 Civic Center Plaza Santa Ana, CA 92701 3. Additional Premium: (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 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 constriction or demolition operations performed by or on behalf of the person or organization shown in the schedule. CG 20 11 1185 Copyright. Insurance Services Office, Inc., 1964 Page 1 of 1 CL # 49286