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Home My WebLink AboutSEHUAME, RUDY R. 1Fc 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 UIN 18 Pas 1� VII Please complete this form when the attached agreement is no longer in effect.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 - 029-06 UNTIL INSURANCE EXPIRES /— / - / , ei CLERK OF COUNCIL DATE JuL 1 3 2011 RiXTH AMF.NnMF.NT TC) A�:RF.F.MF.NT THIS SIXTH AMENDMENT TO RECREATION SERVICES AGREEMENT is made and entered into this 17t' day of June, 201 1 by and between Rudy R. Sehuame, (hereinafter ce "Provider "), and the City of Santa Ana, (hereinafter "City "). U RECITALS: ay 1 . The parties entered into Agreement N- 2006 -029, as amended from time to time, O (hereinafter the "Agreement ") by which Provider has provided martial arts instruction in the City's leisure program. In accordance with the terms and conditions of said Agreement, the parties wish to revise the Scope of Services (Exhibit A), and extend the term 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 and previous Amendments, except those amended in this Sixth Amendment to Recreation Services Agreement, the parties agree as follows: 7. Section 1, SCOPE OF SERVICES, shall be amended by substitution of a new Exhibit A, attached hereto. 2. Section 3, TERM, shall be amended to extend the termination date to June 30, 2012. 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 Sixth Amendment to Recreation Services Agreement on the day and year first set forth above. ATTEST: CITY OF SANTA ANA Maria D. Huizar, Clerk the Council PAUL M. WALTERS APPROVED AS TO FORM: City Manager Jo p Straka, Interim City Attorney PROVIDER: RECOMMENDED FOR APPROVA ��f� R R. HUAME Gerardo Mouet, Exe. D rec or PRCSA EXHIBIT A SCOPE OF SERVICES 1. Provider will prepaze and instruct students in martial arts techniques, with an emphasis on Karate (Sehuame Bu- Jyutsu). Provider will also instruct Self - Defense and Cardio Kickboxing classes 2. Consultant will provide and be responsible for equipment, records, and personnel an d clean up of the facilities and materials necessary to ensure the safety and effectiveness of said instnuctin n_ 3. If Consultant allows others to teach his/her class, those teachers must be over 21, have obtained and maintain an instructor rating, and be covered by Consultants' insurance. Consultant shall provide City with documentation to verify instructor and insurance requirements. Black -belt rated students may warm up beginning students, however, Consultant 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. Consultant will be under no obligation to provide services and the City will have no obligations to pay Consultant 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. Consultant shall not collect fees, but shall refer all interested participants to City for registration. 4. Consultant shall receive seventy per cent (70 %) of the total fees collected each month. City and Consultant agree that City shall retain thirty per cent (30 %) of the fees collected as an administration fee. 5. Consultant agrees that City is entitled to audit Consultant's records and classes to insure compliance with this Agreement. 6. Consultant may not waive class participation/ registration fees. 7. City shall prepare class rosters and provide a copy to Consultant. Only registered participants may participate in class. 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 20 Civic Center Plaza P. O. Box 6450 Santa Ana, CA 92701 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 N- 2006 -029 -06 *Liquor Liability Yes � No - * *Li uor Liabili 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 LIABILI'T'Y 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) 1,000,000 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, the person or organia[ion shown in this schedule, but only with respect [o liability arising out of the ownership, maintenance or use of the premises used by [he 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 CAN ATION� Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovisioru. Ev effort will be made to deliver 30 da s written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: � � c�J�^�! a )'t� { DATE ISSUED: February 02. 2011 by Briza Morales - " ---� ` - "��2 � —��a SCltt Sli %assistant City A EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-08 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. an 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 L icense No: OC 36861. NAMED INSURED (EVENT HOLDER): EVENT INFORMAT[W Rudy Sehuarne TYPE: Martial Ats 2424 W. First Street, #133 DATE(S): 01103112 —12131112 LOCATION: Santa Anita Center , Santa Ana, Cr" 9270�3 *Liquor Liability Yes [I N o Z cx�) C (1z "Liquor Liabilit after 12 am ends before 2 am El _y 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: 12SEPI00000I MASTER POLICY DATES: EFFECTIVE. JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LIABILUY OCCURRENCE FORM DEDUCIIBLE: NONE General Aggregate Limit 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) 100,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) I,000,000 Optional Limits Purchased F-1 simmoo/smoomoo [:] $2,000,00052,000,000 The limits of insurance apply separately to each event insured by this Policy as if 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 vMh respect to liability arising out of the ownership, maintenance or use ofthe premises used by the named insured (event holder). 'rhis insurance does not apply w Any "occurrence" which takes place after the event holder ceases to be a tenant, in that premises OTHER ADDITIONAL INSUREDS .CAN. Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions, MU # as 1013 VA 10 011 R 0 2 R 1 W; 12 V 611 W; I DATE ISSUED: O L/Q-1/1 2 by-Briza Morales . ............... .. . __ .. . ....... _