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Home My WebLink AboutSEHUAME, RUDY R. 1ec a oob AGREEMENT TERMINATION 2011' . UIN 18 Pas 1� VII Please complete this form when the attached agreement is no longer in effect. Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647 =1138 if you haveany questions. The agreement with � 1 r No. was completed on and final payment has been made. N _a- oou -MA- a - fv - a- O0 (t - a2.9 -03 v co Department: T �-� 4 Signature: Q—k Revised 3-2-07 Date: U 1 1 31 i -ci City of Santa Ana Clerk of the Council INSURANCE ON FILE WORK MAY PROCEED N- 2006 -029 -05 UNTIL INSURANCE EXPIRES /- /-ZO{/ CLERK OF COUNCIL DATE: JUL ]_ 9 20jQ AMENDMENT TO AGREEMENT o- FRCS (a ) Donna Schultze THIS FIFTH AMENDMENT TO AGREEMENT is entered into this 1 day of July, 201 O, between Rudy Sehuame (hereinafter "Provider ") and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City "). RECITALS: A. The parties entered into Agreement N- 2006 -029, as amended from time to time dated, hereinafter referred to as "said Agreement" by which Provider provides recreation and leisure class services. B. The parties wish to amend said Agreement to renew the agreement for another one year term and to revise the Scope of Services (Exhibit A). 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 Second Amendment to Agreement, the parties agree as follows: 1. Section 1, entitled "Scope of Services ", shall be amended by substitution of a new Exhibit A, attached hereto. 2. Section 3, TERM, shall be deleted in its entirety and replaced with the following: "This Agreement shall commence on July 1. 201 O and terminate on June 30, 2011, unless terminated earlier in accordance with Section 12, below." 3. Except as herein amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to Agreement the date and year first above written. ATTEST: � � �J__�, MARIA D. HUI7.A.R Clerk of the Council CITY OF SANTA ANA DAVID N. REAM City Manager APPROVED AS TO FORM: PROVIDER Ru"cYy Sehuame Tax ID No. Exhibit A SCOPE OF SERVICES 1. Provider will prepare and instruct students in martial arts techniques, with an emphasis on Karate (Schuame Bu- Jyutsu). 2. Class will meet at the Santa Anita Recreation Center on Monday and Wednesday evenings, from 6 -8pm for ages 5 to 18 years of age. The City reserves the right to preempt any class as City deems necessary. Thirty (30) day notice of such change will be provided, if possible. Instructor may reschedule any class which has bee preempted. 3. Provider will provide and be responsible for equipment, records, personnel and clean up of the facilities and materials necessary to ensure the safety and effectiveness of said instruction. 4. If Provider allows others to teach his/her class, those teachers must be over 21, have obtained and maintain an instructor rating, and be covered by Providers' insurance. Provider shall provide City with documentation to verify instructor and insurance requirements. Black -belt rated students may warm up beginning students, however, Provider must be present at all times. CLASS SIZE REGISTRATION 1. The minimum number or participants is 5 per class, the maximum is 25. 2. No registration will be accepted after the second week of classes. 3. In the event the minimum number of enrollees is not realized by the second meeting of the class, the class shall be canceled. Provider will be under no obligation to provide services and the City will have no obligations to pay Provider compensation. FEES 1. Each participant shall pay a $25.00 class registration fee per monthly session. 2. No refunds will be made to participants after the commencement of a session unless the class is cancelled by the City. 3. The City shall collect registration fees from each participant during the registration period. Provider shall not collect fees, but shall refer all interested participants to City for registration. 4. Provider shall retain seventy per cent (70 %) of the total fees collected each month. City and Provider agree that City shall receive thirty per cent (30 %) of the fees collected as an administration fee. 5. Provider agrees that City is entitled to audit Provider's records and classes to insure compliance with this Agreement. 6. Provider may not waive class participation/registration fees. 7. City shall prepare class rosters and provide a copy to Provider. Only registered participants may participate in class. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2010 -003 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P. 0. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Karate 2424 W. First Street, Space 133 DATE(S): 1/7/10 - 12/18/10 Santa Ana, CA 92703 LOCATION: Santa Anita Park "Liquor Liability Yes ❑ No kt "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated. 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: 10SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2010 EXPIRATION: JANUARY 1, 2011 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products& Completed Operations 1,000,000 O FORM pS Personal& Advertising Injury 1,000,000 N�PViOVED Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments One Person) 5,000 (Any JOSEPH Liquor Liability (If purchased) 11000,000 TTO NEY C The limits of insurance apply separately to each event insured by this policy as if a separa icy of insurance has been issued for that event. "Who is insured" is amended m include, as an insured, the person or organisation shown in this schedule, but only with respect to liability arising out of Ore ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: 11a �� DATE ISSUED: January 7, 2010 by Briza Morales W EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2011 -13 CERTIFICATE OF INSURANCE COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services C> _ 20 Civic Center Plaza /� � %� _ C,� g —�,� � � P. O. Box 6450 Santa Ana, CA 92701 / l� �- "� Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Rudy Sehuame TYPE: Martial Arts 2424 West 1 °`, #133 DATE(S): 02/02/11 — 12/31/11 Santa Ana, CA 92703 LOCATION: Santa Anita Recreation *Liquor Liability Yes � No * *Li uor Liabilit after 12 am ends before 2 am � This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 11SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products 8c Completed Operations 1,000,000 Personal 8c Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) l,000 000 The 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, [he person or organization shown in this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (even[ holder). This insurance does not apply to: Any "occurrence" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovi sions. Eve of %rt will be made to deliver 30 days written notice to the certi£cate holder and additional insureds) listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: February 02. 2011 by Briza Morales