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Home My WebLink AboutHERNANDEZ, FLOR 1CG) AGREEMENT TERMINATION C zo01 s✓ CPT i SA' A Please complete this form when the attached agreement is no longer in effect tj E R In 0 Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions. The agreement with No. N�t��'-I�r was and final payment has been made. rJ a0026--l'vel-®O N Revised 05-22-08 ted on(� \ t ® I Department: Signature:i Date: ! G. City of Santa Ana Clerk of the Council INSURANCE ON FILE VVORK MAY PROCEED UNTIL INSURANCE EXPIRES /*?- CLERK OF COUNCIL DATE N-2008-139-003 JP,% 8 THIRD AMENDMENT TO AGREEMENT O: PRCS (/ ) THIS AGREEMENT made and entered into this 2"d day of December, 201 1 by and Silvia Cueva$etween Flor Hernandez hereinafter "Provider" and the City ( ), of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws ofthe State of California (hereinafter "City"). RECITALS A. The parties entered into Agreement N-2008-139, dated October 10, 2008, (hereinafter "said Agreement") by which Provider has provided Aerobics classes through the City's leisure class program- B. Said Agreement has been amended to extend the term and revise the Scope of Services. C. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one-year period and to revise the Scope of Services. NOW THEREFORE, in consideration ofthe mutual and respective promises, and subject to the all the terms and conditions of said Agreement, except those amended in this Third Amendment to Recreation Services Agreement, the parties agree as follows: 1. Section 1, Scope of Services is amended to be as provided in Exhibit A, attached hereto. 2. Section 3, TERM shall be amended to extend the term through December 31, 2012. 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: -'CITY SANT -ANA L�/?� �� .cam •%�/i � � _ MARIA D. HUIZAR PAUL M. WALTERS Clerk ofthe Council Interim City Manager APPROVED AS TO FORM: AA JOSEPH STRAK Interim City Attorney RECOMMENDED FOR AP OVAL: PROVIDER GERARDO MOUET I FCYR HERNANDEZ Executive Director of Parks, Tax ID# Recreation and Community Services EXHIBIT A SCOPE OF SERVICES 1) Provider will provide beginning aerobics classes for the City's leisure class program. 2) Provider will use accepted safe and healthy Aerobics techniques, warm-up exercises and steps as well as cool down_ 3) Provider shall provide equipment, records and personnel necessary to ensure the safety and effectiveness of said instruction. 4) Provider shall inform City of the day and time of the classes to be conducted by Consultant. Provider and Parks, Recreation and Community Services staff may change the days, time and/or location ofthe classes to be held during a given monthly session, upon mutual agreement. CLASS SIZE 1) Each class must have a minimum of 10 paid students and a maximum of 40. 2) No registration will be accepted after the second meeting of class. 3) In the event the minimum number of enrollees is not realized by the second meeting of the class, the class may be canceled by mutual agreement of Provider and City, with no compensation owed to Provider for any cancelled class session_ CLASS FEES 1) The beginning aerobics fee is $1 5.00 per month or $5.00 per class. 2) No refunds will be made to participants after the first week of class 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 (301,16) of the fees collected as an administration fee_ 5) Provider agrees that City is entitled to audit Providers records and classes to insure compliance with this Agreement. 6) Provider may not waive class participation/registration fees_ Only registered participants may participate in class. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2012-03 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRARf 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 Newport Beach, CA 92658 Santa Ana CA 92701 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Flor Hernandez TYPE: Aerobics 13100 Chapman Ave., Apt. 3-108 DATE(S): 01/03/12 — 12/31/12 Garden Grove, CA 92940 LOCATION: Jerome Center, Loean Center *Liquor Liability Yes Q No **Li uor Liability after 12 am ends before 2 am 0 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 NUtNIBER: 12SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1, 2013 COMMERCIAL GENERAL LL4BILUUY OCCURRF_NCE FORM DEDUCTIBLE: NONL. General Aggregate Limit $ 2.000,000 Products 8 Completed Operations 1,000,0oo Personal Advertising Injury 1,000.000 Each Occurrence Limit 1,000,000 Fire l>—ge (Any One Fir.) 100,000 Medical Payments (Any One Person) 5.000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased 0 51,000,000/S3,000,000 0 $2,000,000/$2,000,000 The limits of insurance apply se stately w each event insured by this olicv xts if a sc aratc. policy of insurance has been tssuod for that event. "Who is insured" is amended to include, as an insured, the person or organization shown in [his schedule, but only with respect to liability arising out ofthe ownership, maintenance or use ofthe premises used by the named insured (event holder). This insurance does not apply to. Any "occurrence" which takes place alter the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELi_A T] )NV Should the above d -scribed policy be cancelled before the expiration date thereof. notice will be delivered in accordance with the policy rovisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 12/20/11 by Briza Morales EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2011-10 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 Citv 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: Flor Hernandez TYPE: Aerobics 13100 Chapman Ave., Apt. 3-108 DATE(S): 01/19/11 — 12/31/11 Carden Grove, CA 92840 LOCATION: Jerome, Loean, Santa Ana Centers _ *Liquor Liability Yes 0 No **Liquor Liability after 12 am ends before 2 am E 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(ics). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 11SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 ('OMNIFRC'IAL Cil?NFRAL LIABILITY OC'C'URRENC'E FORM DF.DI1("I'II31 F: NONF General Aggregate Limit S 2,000,000 Products & Completed Operations 1,000,000 Personal & Advenismg Injury 1,000,000 I ach Occurrence Limit 1,000,00) 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,fa separate policy of insurance has been issued for that event. "who is insured" is amended to include, as an insured, the person or orgam—ion shown in this schedule, but only with respect to liability arising out ofthe 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 alter 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 provisions. Every effort will be made to deliver 30 clays written notice to the certificate holder and additional msured(s) listed. �f AUTHORIZED REPRESENTATIVE: DATE ISSUED: