HomeMy WebLinkAboutRIVERA, SALOMON 1fCity of Santa Ana
Clerk of the Council C 2a`j
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in Orct P„ n= t
Return form to the Clerk of the Council Office (M-30).
Call 647-5237 if you have any questions. t.
The agreement with
No. A-2006-263-1 '3 O-r) was completed on I®
and final payment has been made.
K2 N - 200i -033 l() cord Department:
4 N•2004•033-01 j A-2o0b2d3-®2(le)
Phone/Ext.:
4-u - 2ool-033-07 � z0pb-2d3 o9(Is)
*A - 20o6- 263 Signature:
'*A - J06 b - 20'0l Date:
Revised 07-23-07
I':1
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CLERK OF NEAL
DATE V Z009 SIXTH AMENDMENT TO AGREEMENT
4
* P TIC
)ehL T141S SIXTH AMENDMENT TO AGREEMENT is made and entered into this 3day of June,
Njr,,�y)ez 2009 y and between the City of Santa Ana, a charter city and municipal corporation of the State
of California ("City') and Salomon Rivera "Consultant" .
RECITALS:
City and Consultant entered into Agreement N -20 0 - 0 3 3, dated April 22, 2004,
Amendment N-2 - - 1 dated Decemb er 3 01 2004, Amendment N#2 - - 02
dated December 30, 2005, Amendment A-2006-263 dated September 18, 2006,
Amendment A-2006-263-01 dated April 25,2007, and Amendment A-2 0 -263- 2
dated May 16, 20 08 hereinafter "said Agreement", by which Consultant has
instructed salsa dance classes through the City's leisure class program.
2. In accordance with the terms and conditions of said Agreement, the parties wish t
renew the said Agreement for an additional one-year period.
WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all
the terns and conditions of said Agreement, except those amended in this Third Amendment to
Agreement, the parties agree as follows;
I . Section 3, TERM, shall be amended to extend the term of said Agreement through
June 3 0, 201 .
2. Except as herein amended, all terms and conditions of said Agreement shall rena in
full force and effect.
IN WITNESS WHEREOF, City and Consultant have executed this Sixth Amendment to
Consultant Agreement on the day and year first set forth above.
ATTEST:
Patricia E. Healy
Clerk of the Council
APPROVED AS TO FORM:
Joseph W. Fletcher, City Attorney
Kylee Otto
Assistant City Attorney
CITY OF SA ITA ANA
Gerardo Monet, ectie Director
Executive Dig+ec r
Parks Recreation and Community Services
E v ANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2009-01
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PFtODI TCER:
PUBLIC ENTITY (ADDITIONAL INSURED)
City of Santa Ana
A. Iiant Insurance Services, Inc. in conjunction with
20 Civic Center Plaza
Apex Insurance Services
Santa Ana, CA 92701
I' O. Box 6450
Nhtwport Beach, CA 92658
(949)660-8135
_License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
Salomon Rivera
TYPE: Dance - Salsa
709 S. Parton Street
DATE(S): Jan. 5 - Dec. 31
Santa Ana, CA 92701
_
LOCATION: Southwest Senior Center
*Liquor Liability Yes ❑ No
— ---
**Li uor Liabilit after 12 am ends before 2 am ❑
7 •ius is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period
nlicated. 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: 04SEP1000001-5
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2009 EXPIRATION: JANUARY 1, 2010
( � fMMERCIAL GENERAL LIARILfTY
Otneral Aggregate Limit
OCCURRENCE FORM DEDUCTIBLE: NONE
$ 2,000,000
Products & Completed Operations 1,000,000
Personal & Advertising Injury 1,000,000
Each Occurrence Limit
1,000,000
Fire Damage (Any One Fire)
50,000
Nl-dical Payments (Any One Person) 5,000
Liquor Liability (If purchased) 1,000,000
I I e limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
"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
nvmership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place
aver the event holder ceases to be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
C \NCELLATION, 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.
I7'CHORIZED REPRESENTATIVE:
A,rF ISSUED: / / 5 /O