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Home My WebLink AboutRUFFIN, DON A. AND ARLENE B. 1AC coq AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have anj- 't' .qq,E� ions,' The agreement with No. and final payment has been made. - aw) � -WI-C) i � -,aD C) S- -0 Q3 -03 N -SLOC) Revised 05-22-08 �WAIWI N U WV was completed on Department: F aj�Js A Signature: sS� JW \jCA � A )()—A1G0 Date: to 11,°z 1) 4- City of Santa Ana Clerk of the Council `.` r; , ; r PRQCEEC UiN I iL iNSuRA NCE EXPIRES CC_ERK OFCOUNCI JN 2 09 DA rE: FIRST AMENDMENT TO AGREEMENT N -2008- 063 -01 THIS FIRST AMENDMENT TO AGREEMENT is made and entered into this 3rd day of June, 2009 by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City ") and Don A. Ruffin and Arlene B. Ruffin ( "Consultant "). RECITALS: City and Consultant entered into Agreement N- 2008 -063, dated May 8, 2008, hereinafter "said Agreement ", by which Consultant has instructed Tennis through the City's leisure class program. 2. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one -year period. 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 Agreement, the parties agree as follows: 1. Section 3, TERM, shall be amended to extend the term of said Agreement through June 30, 2010. 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 First Amendment to Consultant Agreement on the day and year first set forth above. ATTEST: PATRICIA E. HEAD %� l Clerk of the Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By:� /... Kylee Otto Assistant City Attorney CITY OF SANTA ANA GERARDO MO frof Executive Direct ar ks, Recreation and Community Services . . , . IT- ;006- (-)(,-3 ACORD. CERTIFICATE OF LIABILITY INSURANCE page 1 of 3 12/31/2008 PRODUCER 877- 945 -7378 Willis BRH 26 Century Blvd. P. O. Bex 305191 Nashville, TN 372305191 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA'T'ION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED United States Professional Tennis Association, In 3535 Briarpark Drive Houston, Tx 77042 .INSURERA:Philadelphia rudemnitX Insurance CompnX 19058 -001 INSURERS: Fireman's Fund Insurance Co. 21813 -091 INSURER C X INSURERD: PHPX370771 INSURER E: 12/31/2009 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 CONOTTIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tN8R IR TYPEOFIRSURAN09 POLICYNUMBER CYE FE IVE POLICY EIMM11RDAT N LINTS A X GENERALLIABAIIY PHPX370771 12/31 /2008 12/31/2009 EACHOCCURRENCE s 11000.000 X COMMI RCW.GENERALLIABIIJTY CLAIMS MADE ® OCCUR IEjI eMI ORE.V- 4Mnce) 3 0 HIED EXP ona person S PERSONAL&ADVRLNRY _ $ 11000,000 GENERAL AGGREGATE f 2,000,000 GEWL AGGREGATE LIMIT APPLIES PM, PRCOUCTS•COMP/OPAGG f :t,000,000 POLICY jec LOO AUTOMOBILE LIABILITY ANYAU TO ALLOWNEDAUTOS SCHEDULED AUTOS APPROVED A T FO """80DILYINJURY COMBINED SINGLE LIMB (Eaaoddent) f (Pe►person) 5 BODILY INJURY (Per accident) f HIRED AUTOS NON- OWNEDAUT03 Ur' S( t hee (PRs°PacelRdeent) AGE f Assists t y Atto ey GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S ANY AUTO $ g EXCESSIUMBRELLAUAMLrrY OCCUR CLAIMS MADE PRUB258269 12/31/2006 12/31/2009 EACHOCCURRENCE f 3[, 000, 000 AGGREGATE S 3,000,000 S DEDUCTIBLE a RETENTION S WORKERS COMPENSATION AND ST TlT1- 0 ' EMPLOYERS' LIABILITY ANY PROPRIETOPiPARTNEWEXECUTIVE OFFICERMFF.MBEREXCLUDED? E.L. EACH ACCIDENT ' $ E.L. DISEASE. EA EMPLOYEE $ If9ya deaaib V—MI0' SPE(�ALPROVISIONSbelow El. DISEASE- POLICY LIMIT f B OTHER SEMOOO81693970 12131/2008 12/31/2009 Excess Liability $5,000,000 Limit DESCRIPTION OF OPERATIONS/ .00ATIONSNEHICLESMXCLUSIONSAWED BY ENDORSEMENTISPECIAL PROVISIONS Arlene Ruffin 54144 USPTA Members are insureds for General Liability for playing, teaching or officiating in tennis or operating a tennis ball machine for practicing or teaching. City of Santa Ana ( Neal Aiachander Tennis Center Santa Ana High School) is an Additional Insured aq respects n r Liability 0 claims arising out of the negligence SHOULD ANY OFIM ABOVE DESCRMED POLICIES HE CANCELLED BEFORE THE VXPIRAT" DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER. ITS AGENTS OR City of Santa Ana ( Neal Machander Tennis Center Santa Ana High School) REPRESENTATIVES. 520 W. Walnut St. R Santa Ana, CA 92701 JIdCt� Ae'non•lc 116AI Innl r- 11 .1!1;'7d9A1 Tn1,R7rf;7r, r_wr.r_ :1 89194 MACORO CORPORATION 1988 11�/�il�s CERTIFICATE OF LIABILITY INSURANCE page 2 of 3 2a,3iTE PRODUCER 877 -945 -7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willie aRE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. o. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE ENAIC# INSURED United States Brofeseional Tennis Assoaiatioa, In .INSURER P: Philadel hia Xndemni Inauranaa Co an 01 3535 Briarpark Drive Houston, TX 77042 INSURERS: Fireman's Puna Insurance Co. 91 INSURER C: Named Insured. lfn 11 .9S-7 d l tt -I Page 3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holier, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. A Cnnn"HN111nn1 .. POLICY NUMBER: PHPK370771 COMMERCIAL GENERAL LIABILITY NAMED INSURED: United States Professional Tennis Association, In 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 COVERAGE PART. Name of Persons or Organization: City of Santa Ana ( Neai Machander Tennis Center Santa Ana High School) (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. CG 2010 1186 Includes Copyrighted Material of Insurance Services Office, Inc. with We permission. Copyright, Insurance Service Office, Inc. 1W United States Professional Tennis Association, Inc. Determining the way the world leans to play tennis USPTA. January 2, 2009 Mr. Don A. Ruffin 35 Field Irvine, CA 92620 -3345 Dear Don: This letter confirms that, as a Recreational Coach of the United States Professional Tennis Association, you have purchased liability insurance as outlined below. This USPTA liability policy covers applicants, and certified and certain honorary members in the United States, its territories or Canada, and nonmembers who are insured through a certified member's policy. It also covers Recreational Coaches who elect to purchase the insurance. THE USPTA LIABILITY POLICY I`N L DEC $9 million liability insurance, while on court, for bodily injury to others, and for damage to property not in the tennis teacher's care, custody or control. It does not cover injury to the tennis teacher, or damage to his /her property. The accident must have taken place on court, and arisen from the tennis teacher's playing, practicing, teaching or officiating in tennis. Policy number: Effective period: For questions or to report an accident, contact: PHPK370771 12/31/2008 - 12/31/2009 USPTA World Headquarters 3535 Briarpark Drive, Suite One Houston, TX 77042 Telephone (713) 978 -7782 ,&,PPROVED AS TO FORM L- {... , c .auiu tii:it „ti Y If we may be of further assistance, please do not hesitate to contact us. Sincerely, A�Ji!butl11 City Attorney, UNITED STATES P OF InO,NA�L TENNIS ASSOCIATION, INC. Meloi:y De ch Insurance D artment 3535 $riarpark Drive, Suite One • Houston, TX 77042 800- USPTA -4U - 713 -97 -USPTA - 713 -978 -7780 Fax • uspta @uspta.org - www.uspta.com United States Professional Tennis Association, Inc. Setting the standard for teaching professionals — That's Who We Are March 5, 2009 Arlene Ruffin 35 Field Irvine, CA 92620 -3345 Dear Arlene: F7 This letter confirms that, as a Recreational Coach of the United States Professional Tennis Association, you have purchased liability insurance as outlined below. This USPTA liability policy covers applicants, and certified and certain honorary members in the United States, its territories or Canada, and nonmembers who are insured through a certified member's policy. It also covers Recreational Coaches who elect to purchase the insurance. THE USPTA LIABILITY POLICY INCLUDES $9 million liability insurance, while on court, for bodily injury to others, and for damage to property not in the tennis teacher's care, custody or control. It does not cover injury to the tennis coach, or damage to his /her property. The accident must have taken place on court, and arisen from the tennis teacher's playing, practicing, teaching or officiating in tennis. Policy number: Effective period: For questions or to report an accident, contact: PHPK370771 12/31/08- 12/3I/09 USPTA World Headquarters 3535 Briarpark Drive, Suite One Houston, TX 77042 Telephone 713- 978 -7782 If we may be of further assistance, please do not hesitate to contact us. Sincerely, UNITED STATES PRQFESSIONAL TENNIS ASSOCIATION, INC. Melony Loaclt Insurance Department 3535 Briarpark Drive, Suite One a Houston, TX 77042 800- 877 - 8248.713- 978 - 7782.713- 978 -7780 £ax a uspta@uspt,Lorg• uspta.com f s E /V' — 20 0 �S — 06 3 - 0 2 �� CERTIFICATE OF LIABILITY INSURANCE page 1 ot: 3 �o1 %oe /�ao 0 PROOUeER 677- 945 -7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS LPON THE CERTIFICATE willies Znauraae• Barvicss o! Georgia, Znc_ ss century Hloa. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TYPE OPIMSURANGE D. O. Hos 305191 Nashville, TN 3723 0 -5191 INSURERS AFFORDINf3 COVERAGE NAICRI WSVRED Dnited StaCaa proiYaional TeTmia Aaaeeiation, Zn .INSURERA�RhLladel his IaauranOe C See 1S0S8 -900 INSV Bs•.BLre>.an• a D'uafl Znauraane CO. 2 18 7 3 -091 3s3s Hrierpar)c Dsivs Neuaeon, TX 770a2 INSURER C: S _� QOO, 000 COMMER ... GENERAL LIABILITY COVE : , =a.i::::,..� -. -.. THE POLICIES OF INSURANCE USTED 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 ISSUEO OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION8 AND CONDITIONS OF SUCH POLICIES. AG�3REGATE LIMITS SHOWN MAY HAVE SEEN REDUCED OY PAID CLAIMS. R TYPE OPIMSURANGE PODGY NUMBER �� SY/31/2009 I 12/31/2 D10 LIMrt3 A X oENERAUMBP.In PHp)C510031 EACNOCCURRENCE ___ S _� QOO, 000 COMMER ... GENERAL LIABILITY Q• NTEO , S 100 O CLAIMS MADE ®OCCUR MEO EXP M aM _ S PERSONAL BADV INJURY f OFiVERAL A00RE0ATE S GEN'L AOGREOAiE LIMIT APPLIES PER= PROOUCTB- COMP /OP AGO f O POLICY LOC AVTOYOHILE LIABILITY ANYAVTO Item ha be COMBINE091NOLE LIMIT (Ee eorJeerLL) s ALL OWNEOAUTOS SCNEOULeDAVTOS Reviewed- BODILY INJIXiY � °`P°"°"I —_ S HODRy1NJVRy (P.I aaTJAant) i _ NIREDAUTOS NON -0WNED AUTOS Approved- 2� / __ PROPHRTY DAMAGE (PEr gctlelt) -- 1 DSte: ---------- OARATiE LfABILITV AVTOONLY -EA ACCIDEM_ S OTHER THAN EA ACC AUTOONLY� AGG i ANY AUTO i A EXGE881YMBRELLA LUBILnY pIiUH293364 12/31/2009 I2 /31/2010 EACH CCURRENCe S 00 OCCUR � CWM9 MADE AOORHOATE S O S s DeoucnaLE s ReTeNrwN s WORI[PJi8 ANDENPLOYER9•LV161Lm1 / WYPROPRIETCR�F WFICE�M�MBER �(NN�MaI�Wr(( ODMPEMSATION "LN 'P.RTN�JRIEXECLIT ^.F'` EXCLVDE09 L_J NNNRII j { f E.L. EACH M:CfI:ENT � ___ _ _ E_L OIHEA3E- FA EMPLOYEE _i _ _ S_ E.1_ DISEASE - POLICY LIMfr -- _ -____ S 1( MNab VIWN Y 8 OTHER eHX 1 12 2 010 BxeePa Liability 53,000,000 Limit DHSCRE'TION OF OPERATIONS I LOGTgNH /VEHICLES / EXCLVeV]NS ADDED BY HNDORSBNENT / 9PHCUILPROVISKINS Arlene RuElin 54144 UBPTA NemberB era SnBnredB Cor General Liability Cor playiag� teaching or oCEiciating in tennis oz operating a tonnie ball alaehine Cor practicing or teaching. City of Santa Ana (Neal Machander Tenaie Center Santa Ana High School) is an Additional Insured as r SHOULD ANY OP THE ABOVE OESCRNIHO POLICE'S BE CANCELLED BEFORE THL GIPIMTNNI GATE TNBREOP, THE ISSUWO WSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE GCRTIFN:ATe MOLDER NAMED TO THE LEFT, BUT PAILVRe TO DO SO SHALL oR08H If0 OBUOATNJN OR LUBILITY OF ANT HIND UPpI THE INSURER, n3 AGENTS OR Ci Cy oL Santa Ana (Heal Naehsnflor Tonaia Center Banta Ana Nigh School) REPREeENTATVEB. Sao w. walaue St. AVTNORI>CZD REPRESENTATVE Santa Ana, CA 92701 ACORD 25 (2006!01) Co 11:2903568 Tp1: 1040196 Cart:13. 765 ®1 BB -2006 ACORD CORPORATION. All rights reserved. The ACORO name and logo are registered marks of ACORD � Page 3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statemerit On this certificate does not confer rights t0 the certificate holder In flea of such endorsamant(s). If SUBROGATION IS WAIVED, aubJect to the terms arld conditions of the policy, eertaln polices may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of insurance does not constitute a contract between the issulhg Irtsurer(s), authorized representative or producer, and the certificate holder, nor does It affirmatively or negatively amend, extend or alter the coverage afforded by the policies hated thereon. Tp1:1o90198 Carta 137267 THIS ENDORSEtitllEhlT GRANGES THE POLICY PLEASE R —�l,D IT CAREPULi.Y ADDITIONAL INSURED: OWNERS AND J OR LESSORS OF PREMISES, LESSORS OF LEASED- EQUIPMENT, SPQINSOR$ OR CO- PRQMOTERS This endorsement tmodittes Insurance provided under the following: COMMERCIAL [iENERAL LU►AILITY COVERAGE PART This policy is amender! t0 includa� as an additional Insured. any person or orgarrizetkxt of the types designated below, but only wtlh neapect to liability .arising aut of your operations- 1. owners end / or !.assort;• of the premises leased. r+entad, or loaned to you. subJect to the toHOwlrtg adtiltlortai exotutrions; a. TMs Instirerlce applies only to an 'occurrence' which (ekes place whtle you are e. tenant In the pnemises; - b_ This insurarvosdoas tw4apptyto'boditylryury or'prtapergr damage` resulting from structural aiteratior►s, flew t:ortatre�eSon or demoRtlon oparattona performed by or on behalf of fha owner end / or Ieasor of Otis j�oeritlssa;. c. TMs Inauartce does. not apply fo ut+trlsty of the orvrters and / or lessors for -bodily lryury or 'property damage` arledr�_ cut of arty design defect or atrudutal maintenance of the premieres ex loss osused by a premises deiect. With respect tD any addltloiial.Bisui!e)d Irrch.ided utrder tflfs pocky, fhia Insurance does no! apply io the sole negligence of audr txttlitlonellnetusd. 2. Lessor of Leased Equi�mertt, but only with raspee;t to tlabfNgr for `bodily injury, 'propergr damage' or "personal and advmritseng injury' caused, M whob or: in part, byyour malrtterlanca, apasatlon or use of equipmerrl teased to you by tiuCtr perann(S) Or organlzatkm(s) si,bject to the followin8 addWonal exdusiona: a. This intraxanoe does not apply to any `occurrence' whictr takes plane esker the equipment tease expires. 3. Sponerors a. co- Prornoiera City of Santa Ana /City Attorney Item has Reviewed: APPrn�ed: Date: Page � oT t United States Professional Tennis Association, Inc. Setting the standard for teaching professionals - That's Who We Are March 21, 2012 Ms. Arlene B. Ruffin 28 Grant Irvine, CA 92620 -3353 -,� Dd 8" - �C�3-023 2 usP-r�.. Dear Arlene, This letter confirms that, as a Recreational Coach of the United States Professional Tennis Association, you have purchased liability insurance as outlined beioty_ This USPTA liability policy covers applicants, and certified -and certain honorary members in 'the United States, its territories or Canada, and nonmembers who are insured through a certified member's policy. 7t also covers Recreational Coaches who elect to purchase the insurance: THE USPTA LIABILITY POLICY INCLUDES $9 million liability insurance, while on court, for bodily injury to others, and for damage to property not in the tennis teacher's care, custody or control. It does nor cover injury to the tennis teacher, or damage to his/her property. The accident must have taken place on court, and arisen from the tennis teacher's playing, practicing, ,teaching -" or ofFiciating in tennis. Yollcy Number: EtfeMlve Period: For questions or to report an accident, contact: If we may be of further assistance, please PHPK801956 12/31/2011 - 12/31/2012 USPTA World Headquarters 3535 Briarpazk Drive, Suite One Houston, TX 77042 Telephone 713 - 978 -7782 do not hesitate to contact us_ Sincerely, t`U` " /N�IjT'(n /ED STATES PROFESSIO AL TENNIS ASSOCIATION, 1NC. Melony DeLo h ��g� - - Insurance De artment E41R- 2DBD- XNF -g2XB 3535 Briarpark Drive, Suite One - Houston, TX 77042 800- 877 -8248 • 713- 978 -7782 - 713 - 978 -7780 Fax • usp[a riluspta.org - uspta.com