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HomeMy WebLinkAboutSUAREZ, RAYMUNDO 2bCity 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AGREEMENT TERMINAYION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES (i_15 -0`7 CLERK OF COUNCIL DATE: 5-10-017 0, PRA C �) Lr.TKo) SECOND AMENDMENT TO CONSULTANT AGREEMENT N- 2005 - 101 -02 THIS SECOND AMENDMENT TO CONSULTANT AGREEMENT is made and entered into this 19`h day of April, 2007 by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ( "City ") and RAYMUNDO SUAREZ ( "Consultant "). RECITALS: City and Consultant entered into Agreement N- 2005 -101, dated June 1, 2005, (hereinafter "said Agreement ") by which Consultant has instructed self defense classes through the City's leisure class program. 2. In accordance with the terms and conditions of said Agreement, the parties wish to renew the said Agreement for an additional one -year period. WHEREFORE, in consideration of the mutual and respective covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, City and Consultant agree as follows: Section 3, TERM, shall be amended to extend the term of said Agreement through June 30, 2008. 2. Except as herein amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, City and Consultant have executed this Second Amendment to Consultant Agreement on the day and year first set forth above. CITY OF GERARD0 M0 ET Executive Direc r Parks, Recreati nand Community Services Agency APPROVED AS TO FORM: ura Sheedy Assistant City tomey a HfRLY % �ACORD CERTIFICATE OF LIABILITY INSURANCE TM. DAT0815120016 1 PRODUCER Phone: (800)395 -BD75 F=: (858)51ao822 FITNESS AND WELLNESS INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 LIMITS A AUTHORIZED REPRESENTATIVE �// erwo GENERAL. UABLITY X COMMERCIAL GENERAL LIABIL CLAIMS MAD OCCUR INSURERS AFFORDING COVERAGE NAIL # Lick: OD28716 EACH OCCURRENCE S 1, 00'000 INSURED INSURER A: Zurich American Insurance Comparty MEO. EXP Vm one pe ) INSURER B: PERSONAL a ADV INJURY RAYMUNDO SUAREZ 610 S TOWNSEND ST SANTA ANA CA 92703 INSURER C: GENERAL AGGREGATE INSURER D: GENT AGGREGATE LIMIT APPUESPE X POLICY PRO- LOC �IT PRODUCTS- COMP,OP AGG. INSURER E: BD 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 PAN) CLAIMS. Nsa ACOI TYPE OF INSURANCE POLICY NUMBER I BiEC1NE rMlpYe]IPwAT1oM LIMITS A AUTHORIZED REPRESENTATIVE �// erwo GENERAL. UABLITY X COMMERCIAL GENERAL LIABIL CLAIMS MAD OCCUR EOLWI2327-02 0611 5/06 0611 SW EACH OCCURRENCE S 1, 00'000 (FA ) $ 100,000 MEO. EXP Vm one pe ) $ 2,500 PERSONAL a ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPUESPE X POLICY PRO- LOC �IT PRODUCTS- COMP,OP AGG. $ 3,66D,000 AUTOMOBILE LIABILITY ANY ALTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-CWNEDAUTOS SINGLE L )LIMIT ( IT S BODILY INJURY (PW Pen S BODILY INJURY (Per actldsM) S PROFERTYDAMAGE acci0enl S GARAGE LIABILITY ANY AUTO AuroomY- EAACCIDENT S OTHERTHAN EA ACC AUTO ONLY: AGG S 3 EXCESS I UMBRELLA LIABILITY OCCUR D CLAIMS MADE DEDUCTIBLE RETENTIONS %I EACH OCCURRENCE S AGGREGATE _ $ S S S WORKERS COMPENSATION AND EMPLOYERS'Lk4MUTY �,pAO�TOxWAanlenlrxisutNe aofcEnA1EMER Elt]ttLUPEPt sl�aAtrnovrswNS O.Iex OTM R E.L. EACH ACCIDENT $ E.L. DISEASE-EA EMPLOYEE S E.L. DISEASE-POLICY LIMIT $ OTHER; DESCRIPTION OF OPERATIONSILOCATIONS /VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS 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 WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM T OPERATIONS AND USSES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED. CFRTIFICATF HOLDER CANCELLATION ACORD 25 (2001108) Certificate # 44517 © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 CITY OF SANTA ANA 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 20 CIVIC CENTER PLAZA INSURER, ITS AGENTS OR REPRESENTATIVES. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE �// erwo Attention: CARLA TOMPKINS Jew ffrey E Frick, CEO ACORD 25 (2001108) Certificate # 44517 © ACORD CORPORATION 1988 POLICY NUMBER: EOL9012327 -02 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 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 its officers, agents,& representatives, & volunteers Primary and non - contributory CG 20 10 1185 Copyright. Insurance Services Office, Inc., 1984 Certificate # 44517 ,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 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MFWDD/YYYY) 0811312008 PRODUCER Phone: (8001 39545075 Fax (858) 519,0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FITNESS AND WELLNESS 380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, E%TEND OR canna eccCiROED BY THE POLICIES BEL SOLANA BENCH CA 92075 POLMY EFFEU. WTE PWDO POUCY EIIPWJTCH DATEwM LIM95 INSURERS AFFORDING COVERAGE NAIC# _ INSURED RAYMUNDO SUAREZ Agenc�Licp_ 0377,645 - INSURERA: Philadelphia Indemnity Insurance Company INSURER B: _ 610 S TOWNSEND STREET INSURER C: SANTA ANA CA 92703 INSURERD: Je Frick, CEO COVERAGES TO THE INSURED NAMED ABOVE FOR THE POUCYPERIOD INDICATED, NOTWITHSTANDING THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN 5SUEO TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR OF SUCH ANY REQUIREMENT, POLICIES RIBED SUBJECT TO ALLTHE TERMS. EXCLUSIONS AND CONDITIONS MAY PERTAIN. HE IN URAN E AFFORDED HAVE REOUCED CLAIMS. LIMITS AGG IVSR ADD 'L TYPE OF INSURANCE PI OLICY RDMBER POLMY EFFEU. WTE PWDO POUCY EIIPWJTCH DATEwM LIM95 LTR iNSa GENERAL LIABILITY PHPM 105 06115108 06115/09 EACH OCCURRENCE $ 1,000,000 pNMCE TO RENTED PREMISES IEa o¢unme) $ 109,000 - Je Frick, CEO Attention: $ _ MMERLIAL GENERAL LIABILITY MEO. EXP (Pny one perspn) $ 2,$60 CLAIMS MADE IX OCCUR PERSONAL a ADV INJURY $ 1,000,000 A GENERALAGGREGATE S 3,000,000 PROWCTSLOMPIOP AGG. $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY JELT La AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO jr (Ea amidwt) ' INJURY ALL OWNED AUTOS J (P., (Per person) 8 SCHEDULED AUTOS - (BODILY INJURY (Per .¢(dent) $ HIRED AUTOS NON- OWNEDAUTOS PROPERTY DAMAGE $ IPer aa,denp GARAGE LIABILITY AUTO ONLY -EA ACLIOENT $ OTTER THAN EA ACC $ ANY AUTO ,,$ AUTO ONLY: AGG EACH OCCURRENCE S EXCESSIUMBRELLAUABIUTY F— i OCCUR i� CLAIMS MADE AGGREGATE S $ DEDUCIBLE -- RETENTION S $ WC STA.r OTHER TO A WORKERS COMPENSATION AND E.L. EACH ACCIDENT S EMPLOYERS' LIABILITY E.L. MSEASE -EA EMPLOYEE S A r 0PP 110"AIItnWW0CECMTNIE S X p•. e.•cro•.�an E.L. DISEASE-POLICY LIMIT 'sPECUI PFIDNBIOIB Eebw OTHER' DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only as respects the operations of the named insured except that liability resulting from the additional insureds sole negligence. Policy is Non-Contributory. Additional Insured Endorsement is Effective: 07123108 CERTIFICATE HOLDER 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 ✓ DO $0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS CITY OF SANTA ANA AGENTS OR REPRESENTATIVES. 20 CIVIC CENTER PLAZA SANTA ANA,CA,92701 `�� AIJTHORREO REPRESENTATIVE / 7 - Je Frick, CEO Attention: $ _ m wrnen rnoDrsoeTiON HARa ACORD 25 (2001108) CenRlCate 9 11611 POLICY NUMBER [PHPK2841051 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 92401 (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 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. CG 20 11 1185 Copyright. Insurance Services Office, Inc., 1984 Page 1 of 1 CL # 49288