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HomeMy WebLinkAboutHERNANDEZ, FLOR 1DG) AGREEMENT TERMINATION C zo01 s✓ CPT i SA' A Please complete this form when the attached agreement is no longer in effect tj E R In 0 Return form to the Deputy Clerk of the Council (M-30).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 N-2008-139-004 cn P PCs C I) INSURANCE ON FILE-,Av,C, C VIPvQs WORK MAY PROCEED UNTIL INSURANCE EXPIRES FOURTH AMENDMENT TO AGREEMENT CLERK OF COUNCIL DATE: DEC 18 2012 THIS AGREEMENT made and entered into this /3-A day of �ZC,2,2,Ze 2012 by and between Flor Hernandez (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-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 from time to time 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 extend said Agreement and to revise the Scope of Services. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except those amended in this Fourth 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, 2014. 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 OF/ SANTA ANA MARIA D. HUIZAR PAUL, M. WALTERS Clerk of the Council City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: 1/5jp , Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROV PROVIDER u /—YZ,� oC 1 GERARDO MOUE FLOR HERNANDEZ Executive Director, P CSA EXHIBIT A Provider will provide Aerobics classes as follows, on dates and at City facilities approved by leisure class program managers: AEROBICS $15/Month ($35 Bundle/Month) STEP AEROBICS $20/Month ($35 Bundle/Month) INSTRUCTOR: Flor Hernandez CLASS SIZE Each class must have a minimum of 10 paid students and a maximum of 40. If the minimum registration has not been reached by the second class, the class may be cancelled by mutual agreement of Provider and City, without any compensation owed to Provider. CLASS FEES Class fee is $15.00/$20.00 and $35.00 a month. Anticipated revenue from this class is not to exceed $25,000 annually. No refunds shall be made to participants after the first week of class unless the class is cancelled by the Parks, Recreation and Community Services Agency. The City shall collect the class fees from each participant during the registration period. Provider shall not collect fees, but shall refer all interested participants to City for registration. City agrees to pay Provider seventy per cent (700/6) of the total fees within fifteen (15) working days after completion of the class session. City and Provider agree that City shall retain thirty percent (301/o) of the fees collected. Provider agrees that City representatives shall be entitled to audit Provider's records to insure compliance with this Agreement. EVANSTON INSURANCE COMPANY CERTIFICATE NO.- 2012-03 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER I 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 N-2008-139-004 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,Center *Liquor Liability Yes 0 No `*Li uor I iabili after 12 am ends before 2 am 0 This 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 herein is subject to all the terms, exclusions and conditions of such policy(ies). INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 12SEPI000OOI MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2012 EXPIRATION: JANUARY 1. 2013 COMMLRCIAL GENF_RAL L(ABILri"Y General Aggregate Limit S 2.000.000 OCCURRENCE FORM DEDUCTIBLE: NONE, Products 8 Completed Operations I.ODO,000 Personal 8c Advertising InJ ury 1.000.000 CFach Occurrence Limit 1,000.000 Fire Damage (Any One Fire) 100,000 Medical Paymmta (Any One Person) 5.000 Liquor Liability (If purchased) 1.000.000 Optional Limits Purchased 0 S1,000,000/S3,000,000 52,000,000/S2,000 000 The limiu of insuntnce Iy s arnaely [o each event insured b this lieu d ife se tc olic Of iraurnnce has born issued for the[ cwmt. "Who is insured" is rmetuleal to include, at an insured, the person car organtfation shown in th,s schedule, but only with respect to liability arising out of the ownatship, maintenance or cave of the premtsas used by [he named —wed (event holder). This i­cu does not apply to: Any "occurrence' which takes place after the event holder -cakes to be a tenant in that remises. OTHER ADDITIONAL INSUREDS CANCFI. lATIONShmrld the above described polity be oanaelIe d hefere the expiration date [hereof. nonce will be delivered in accordance with the policy revisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 12/20/11 by Briza Morales EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2013-04 CERTIFICATE OF INSURANCE 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: Flor Hernandez TYPE: Aerobics 3939 W. El Prado Ave., Apt. D DATE(S): 01/07/13 — 12/31/13 Orange, CA 92868 LOCATION: Jerome Center and Loean Center *Liquor Liability Yes [—] No EK **Liquor 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 NUMBER: SEP41011 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2013 EXPIRATION: JANUARY 1, 2014 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLENONE 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) 1,000,000 Optional Limits Purchased Q $1,000,000/$3,000,000 o $2,000,000/$2,000,000 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 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 (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, notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2014.16 CERTIFICATE, OF INSURANCE 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 R 0. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Flor Hernandez TYPE: Aerobics 3939 W. El Prado Ave., Apt. D DATE(S): 01/07/14—12/31/14 Orange, CA 92868 LOCATION: Jerome Center and Logan Center *Liquor Liability Yes[] NoZ "Liquor Liability 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 of negativelyamend, 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: SEP41014 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2014 EXPIRATION: JANUARY 1, 2015 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE. General Aggregate Limit $ 2,000,000 Products & Completod 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) 1,000,000 Optional Limits Purchased 1-1 $1,000,0001$3,000,000 ❑ $2,000,000/S2,000,000 Property Damage (If purchased) ❑ Limit S30,000 Deductible$500 ❑ Limit$100,000 Deductible $1,000 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 with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "weirmence" which takes place after the event holder ceases to be a tenant in thatpremises. OTHER ADDITIONAL INSUREDS CANCELLA'CION: 5lvould the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovisiars. "'`tea ace AUTHORIZED REPRESENTATIVE: DATE ISSUED: January7 2014 by Briza Morales EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 201446 CERTIFICATE OF INSURANCE 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 Al-aoo�-��� oo y Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Flor Hernandez TYPE: Aerobics 3939 W. El Prado Ave., Apt. D DATE(S): 01/07/14—12/31/14 Orange, CA 92868 LOCATION: Jerome Center and Lo-an Center *Liquor Liability Yes ❑ No "Liquor Liability 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: SEP41014 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2014 EXPIRATION: JANUARY 1, 2015 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE, 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 Dunnage (Any One Fire) 100,000 Medical Payments (Any One Person) 5,000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,000/$3,000,000 ❑ $2,000,000/$2,000,000 Property Damage (If purchased) ❑ Limit $50,000 Deductible $500 ❑ Limit $100,000 Deductible $1,000 The limits of insurance apply separately to each event insured by this pol ioy 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 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 (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 Geraldine Valencia CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy revisions, AUTHORIZED REPRESENTATIVE: DATE ISSUED: January 7, 2014 by Briza Morales Revised 4/29/14 to include Al. B.M.