HomeMy WebLinkAboutSUAREZ, RAYMUNDO 2eCity 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amendments (if any) are no longer in effect.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
INSOWCE ON Fla N-2005-101-05
UN%IINNSURANOEE
I
CIEBN OF COUNCI6 AMENDMENT TO AGREEMENT
oAIE: AUG 16 �C10
O;PRCS ICI
Silvia Cuevas THIS AMENDMENT TO AGREEMENTis enlaced info this 1st day of July,
2010, hetweenRaymundoSuataz ( hereinafter" Ptor�der ")andtheCityofSan�aAna,a
charlercilyand muttGpal co[porationorgartized and erJStingunderihe ConsGtulionand
Iawsofihe State oP California (hereioafter "City ").
RECCfALS:
A.
servicea
B. The parties Aqsh to amend aid Agreement to ienew litic agreement for anoilter one
year term and to revise [he Scopeof Servic¢s (Exhibil 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 N tals
Second Amendment to A�¢emenf, the parties en�ee as follows'.
1. Section 1, entitled "Scope of 9ervi�`, sill he amended by substitution of a new
Er�ibil A, attached hereto
2. Secfion3, TERM, sha116edeleRdinitsentiretyaridreplacedwifhihefollowing.
The parties entered into Agreement N-2005-101, as amended from time to time dat
"Ttis Agreement shall commence o0 July 1.7x1[0 and le[minate on June 30, 2011,
ualess term�aled earlier in aceordance whh Secticn 12, helCw."
(the "Agaeemanf') by whiff Provider provides racreelion and leisareclass
3. Exceptas herein amended, all terms and conditions of said Agreementshall remain in
full farce and effect.
IIIWITPIESSWfIEREOR, ihepartiesheretohaveeaecutedthisSeeondAmendmentlo
Agreement the date and year firstabove written.
ATTEST: CITY OFSANTAANA
MARIAD�� NUIhARJ DAVIDN.REAM
Clerk of the Council City Manager
APPROVED AS TO FORM:
lOS H ETCHER
Ci Atto y
PROVIDER
Z
Ra uodo 9usrez
Tax IDNo.545�66�0964
ExlribitA
SCOPE OF SERVICES
1. Provider will prepare and instruct students m martial arts techniques, with an
emphasis on Fujitsu far children acd adults,1 and older.
2. The class will be bald monthly at the Southwest Senior Center or Jerome Center
Tuesdays & Thursdays, 630-890 pm. The City reserves the rightto preempt any
class as Ci[y deems necessary. Thuty (30) day notice of such change will be
provided, ifpossible, Instructor may reschedule any class which has bee
preempted
3. Provider will provide and be responsible for equipment, records, personnel and
clean up of tl�efaoilities and materials necessary to ersure the safety and
effectiveness of said instruction.
4. If Provider allows others to teach hismer class, [hose teachers must beaver 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 warn up beginning
students, however, Provider must be present at all times
ChASS SIZE REGISTRATION
FEES
The mNtmum nmmber or pardcipeots is 5 pe<class, the maximum is 30.
No registrationwillbeaceepledafterthesecendweekofolasses.
In theevent Iha minimum number of enrollees isnot realized 6y hhe second
meegng of the class, the class shall be canceled. Provider will beunder no
obligation to provide services and tl�e City will have no obligations to pay
Providercompensation.
Each participant shall pay a $20.00 alassregis(retiou fee pet monlily session.
No refunds will bemade to participants after the commencement of a session
wlesstheclass is cancelled by (he L}ty
The City sha(I eollectregishztion fees Gam each participant during the
registration period. Provider shall not collect fees, butshall refer all interested
participanistoCityforregistrstiom
Provider shall retain seventy per cent (10 %) of the total fees collected each
monG. Ci[y and Provider a�ee that City shall receive lalrry per cent (30 %) of the
fees cellected as an admhnskation fee.
Provider agrees That City is entitled to audit Provider's recerds and classes to
insure compliance with this Agreement
ProvidermaynotwalveclasspadiGpaGonlre�siraticnfees.
City shall prepareclass rosters and provide a copy to Pmvtder. Only registered
participanismaypadieipateinclass.
EVANSTONINSURANCEWMPANY
CERTIFICATE NO; 2010 -009
CERTIFICATE OPINSURANCE
NOMINEE EVENTS,
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENITTY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. inoonjonctlonwith City of Santa An
Apex lnsurance5¢ruicea 20 Civic Center Plaza
P, 0. Box 6450 Santa Ana, CA 41101
Nt;WBeach,CA92W
License No :OC6861
NAMED INSURED (EVENT HOLDER): EVENT INFORMATION:
RaymundoSoarez TYPE: MarlialAra
6I0S.TownseodStreet DATE(S), 01-1211840
SantaAaa,CA 92107 LOCATION, BI Salvador RecreatianCenter
'Liquor Liability Yes 0 Nog
"Liquor Liability afler12amendsbefom2am�
Ttdsistoc¢rtf that the policies of casumm listcd below have ban issued to the insured iscomed above for the Policy Period
md'rcaleti. Notwithstanding any ioquiremmits, zins or coashtions; ofiraymnaitt or otherdoescricertwincresitNtt which this
ceNfieafemayb¢ isouedoruaypeAam the vmmance afforded by 0m poEcfcs dasmbedherenia aubjectro dltmte
, tns,
ezcluaions and conditions of such policies , Lint shown may have been rodo¢¢Ahypaid claims,
INSURANCE CARRIER, Evmstonlnsmanne Company
MASTER POLICY NUMBBR: IOSBPIWOWI
MASTDRPOLICYDATBS: DRRECf[VE, IANUARY 1, 2010 EXPHiA7)ON: ]ANUARY 1, 20(1
CGMMERCIALOEN6PALLNBI11Tti' CCCUPAENCEFORId DE �, NON5
Gmu9 A�f¢ppklimil S2,W0,000
Prcdmk @CampktedOpoati ®a I,RO,000 PPROVE I
Personal &Ativ¢rfisinglnjury I,Wa,a00
Fa�O¢4mimoelilrtit I,Wa,WO
Fir¢Gurug¢(MyOn¢Pla) fs,OW
Mctlmal Paym¢nn (AnyonoPwsoa) JOSEP W f CNER
LiquorLiebiEty(Ifpurehased) I,oao,xa RNEY
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AUTHORIZEII REPAESENTATNE: ��
DATEISSUED: Ienuarv12010 by BnzaMmales�wv
AUTHORIZEII REPAESENTATNE: ��
DATEISSUED: Ienuarv12010 by BnzaMmales�wv