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HomeMy WebLinkAboutWELDY, SCOTT DR., DBA SERRANO ANIMAL & BIRD HOSPITAL 7ACity of Santa I i t Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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 No. A - aG 1-3- o-7) was completed on (List all amendments. Use space below if needed.) A_aC)�L'�—JOl Revised 08-23-10 COTC Office Use Only City of Santa Ana a 2 621 Clerk of the Council G(L and final payment has been made. Department: PP42BA Phone/Ext.: gmck Signature: �,✓ Date:C\ A-2014-107 AMENDMENT TO AGREEMENT DATE: q—/ q S A THIMENDMENT, made and entered into this 15"' day of April, 2014, by and between the City of Santa Ana, a charter city and rnunicipal corporation duly organized and, existing Linder the Constitution and laws of the State of California ("City"), and Dr. Scott Weldy DVM, dba Serrano Animal & BirdHospital ("Consultant"). RECITALS A. The City and Consultant entered into that certain Consultant Agreement dated July 1, 2013, hereinafter referred to as "said Agreement" (#A-2013-071), for Consultant to provide veterinary services to the Santa Ana Zoo at Prentice Park. B. The parties hereto desire to amend the Compensation term of said Agreement. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: Section 2 of said Agreement, Compensation, is hereby amended to increase the Compensation by adding Nine Thousand Five Hundred Dollars for a total not to exceed amount of Eighty -Four Thousand Five Hundred Dollars ($84,500.00). 2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST: 13 � Maria D. Huizar ✓/ Cleric of the Council APPROVED AS TO FORM: Sonia R. Carvalho, City Attorney By: Lisa Storck Assistant City Attorney CITY OF SANTA ANA <�Z--) <Z' David Cavazos City Manager CONSULTANT Serrano Animal and Bird Hospital r �^, Scot Weld , VM Owner Ja6- M :?-V. ,g✓y�"""'°'� SERAN-1 OF ID: LMV OAT (IMMiDW YYYYI CERTIFICATE LIABILITY INSURANCE0711 013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poficy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the Veterinary Ins. Services Co. CA License #QF84180 1400 River Park Drive, #180 Sacramento, CA 95815 Kathy R. Noe, CPCU, ARM -VP Co. 21771 Lake F Lake Forest, r OVERAr;FR rPDTICIPATP MIDIACWts- 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 REQUIREMENT, TERM OR CONDITION 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. ' L Ela �i W p =Y�1' TYPegP INSURANCE _IMSR , POtICY NUMBER MMIDoGYY l LIMITS GENERAL 6IABILi1Y � i MACH OCCURRENCE `MAGE7D RENTED— A X. COMMERCIAL GENERAL LIABILITY - X , ZC8Q88873$ 10710112013 07/0112014 PREMISES (Ea occurrence S 1,000r00 _....._J CtAIM$-MADE OCCUR j ! _ MED EAR 3AilY Qne Person) @_ 10,00 1— ®.._..... ee PERSONAL9AW INJURY GENERAI,AGGREGATE 8 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER j I (PRODUCTe-COMPIGPAGO 1,000,0Q X. + POLICY JECTPRO.I LOB x$ i $ AUTrJMOe1LE LUtaIGTY i ; OMi31N a uwl 1,QQ0r0Q {�s gaewenH 16_ A I =ANY AUTO AZ0808$8-788 07/0112043 Q710112014 8401LY INJURY IPerper§6n) $ 'AU. OMUTOS FD ASCHosULED I BODILY INJURY1PzraacidenUTq $ 's NIRE AU OS X NONfiWNED PAOIiO f"Y'DAMA'Gc 9 —_ �iL ,. . AUTOS I -(Praud ent I X UMBRELLA LIAR _-) OCCUR ''= S _ ; FACH OCCUR}ENCE &1,000,00 A EZDEss LIAe LCLAMS-MAD[ f AZC80806738 0710112013 07/01/2014 M AGGREGATE 3. 2,000,00 j DE$} R I RETENTION Sums -- g ItABI1ON V11C LTQRY LIMJ''S : F H A ANW EMPLOYERS LflY YIN ANY PROPRIETORIPARTNEWS(ECUTNE�-^� OFFICERIh1EMSER E%CLVDED'! i i'NIA in NH) I.I� ( WZP81Q12929 0RQ112Q13 67101l2014 EL EACH u;eIOENr _ s 1,00Qr00 iMandalory EL DISEAgE-EAUMPLOYE If yes, acwrcl iae der. ASCRIPTION OF OPERATIONS re],%s - .. iE.L. DISEASE-POUCY IT t � 1,Q00r0Q E.,,.....J ..................e........4e._.- DESCRIPTION of OPERATIONS; LGCAngNs /VEHICLES (Aaaab ACORD 101, AtltliUanal Rem®rks Schedule, it meeasoft Ni mquirod) City of Santa Ana, its officers, agents, employees and volunteers are included as addtional insureds. the insurance provided is primary. "The insurance provided under this policy is Primary & non contributory with insurance to any other available the additional insured" 30 Days NOC/10 Days NOD for non-payment I 01 t Pttor n fifty City of Santa Ana Fin & Mgt Svcs Agency Purchasing Div. 20 Cl Center Plaza M-16 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. AUTHDRMEP REPRESENTATIVE Kathy R. Noe, CPCki, ARM -VP CAI 1988-2010 ACORD CORPORATION. All ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORO Additional Insured — Owners, Lessees or Contractors — AB 90 67 12 93 Policy Amendment Section 11 Insuredf Serrano Animal & Bird Hospital rolia umber AZC80888736 Producer Veterinary his Services Co Effective Bate 07/01 /13 Schedule Name of Person(s) or Organization(s) City of Santa Ana, Its officers, agents and employees 26 Civic Center Plaza Santa Ana, CA 927OI City of Santa Ana, Its Officers, agents, employees and volunteers are included as additional insureds. The insurance provided is primary, uThe insurance provided under this policy is primary and non- contributory with any other insurance available to the additional insured. This insurance applies separately to each insured against whom claim Is made or suit is brought except with respect to the companies limit of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included,"With Respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center plaza, Santa Ana, California 92702. (If no entry appears above„ information required to complete this Endorsement will be shown in the Declarations as applicable to this Endorsement) Ilie following is Added to Part I — WHO IS AN IN- arising out of your work for that insured by or for SURER in the Business Liability Section of this policy you.- 5, The person or organization shown inthe Schedule All other terms and conditions of the policy apply, is also an insured, but only with respects to liability This form must be attached to Change Endorsement when. issued after the policy is written. One: of the Fireman's Fund Insurance Companles as named in the policy. Secretary ----- .?carp 2L .Noe Authorized. Agent A9.900712-9d Connote copyrighted Mauna of Cnsurance SeMmi Offlne, inc, 19M Wicfwefe &a&i co President Date � 'TQ m� A R S� pRGK 4 pttovnev y�ssistant C1t ,j q 0710 ?`2013 15.33 sp,wrod by' AV AtI A PLIT 9499551070 SAW PAGE 02/Ml veterinary IyrafBSsiapsl Listhiiity�°��� insurance Policy \��i\ Certificate o8 insurance 741a pulley provides awtrrrenca cpvaago. plaaapaa'Aaewthe patfiay enrafl+llYr0 / ZURICH PT,R1: Irsomd by fbt stock company bolo» and haralna{Isr called tht rpvptaos.n.ow ctdraa> company 2nr1Clt.4astosUMN daaurapcc CaxepnnY 1TR1412: Nomsd Csrsafloste Holder, member ammbar, 9RCt and addrdss Scott Henry Weldy, DVM c/o Serrano Anivid ek Bird Hosp 21771 'Lake Fore at, Suite 119 LakeForost, }CA 9263p0-2782 [[ l�l�Brrt�A �Il�ilt[1)I�lilllf�l�lER�f1�9Pi�kf�N l�tAt��li��rl h2emlez memr o = Class W1 LDX SCOOT HAIRY DR 24154 17 IV I9.7ht 5: Ptemium and coverdgc avrdmay Liability $ 222.00 Veterinary, License Defonse $ 651. 00 TOTAL DUE. $ 291- 00 NbsterFolloy Nuastbar, I Certificate Number: EOL 3241502.08 1 36548 FOR TKFORMATION Olt TO FEE A CLAIM FLVASJ CALF, (800) 228 7549 d"f$M3r Poky Pmiod Proms 1/01/2013To. 1101/2014 12:0 un 54WWd time at Ute adtUaas ofshe Named Cartitiaata Held" as elated herein 1`I'RM Ak Lltortt of Liability Each claim Aggregate Fauns Agn6od at losnwunI: IA'Rh47; Module of Plan Numbtraand Veterinary Professional Bette 8tttcnslon For additional locaitmts, Please me the sit LarsLon Na:~xbtrtFiddress P4Bc JTRK8i Verolnary Professional Liability Regulatory Action This cadfioata amanraaa if Wiped oaths M.Rtm DcfaasaCocFaragd enddrsCmrnt(ifputc6ssadj; LtmitS 25,000 Vvedicai Aaaoah0cn, (ANAA}Profoeaiowd Llabili AuthoriAed Spam ,kmG9ar a�.ETN Nadaa So fhm.Campaoy:. , 't S� . 1 at' $1,000,000 $ 3,000,000 P1 n 4am6er old by the Amodaan va4esinary no TrwL ey aaocpimxa of d+i Ana la theoardfloata ondda Was R*Ww+a agaantoals Bud lMlaW`ag 6aEWaBAAtba {?rflliBad sea reimingto this fhsweeaa. W;ftlo0a4 ass LISA k. S�URCu �. Asistant CItV Alto' , ,' l// 07/t3312013 15:33 949855107D WH Fxx server 7/ZtZOI,9 9:36:40 PH PAM PERSONAL AUTO rri*llkentury POLJGY DECLARATION 1riguran0o MARIE V MPY $$OTT WEU>Y 22071REVFRF,RO 2/005 Fax t3Qxvar Page 1 012 ANNEWAL EFF"EMVlri 04rsW19 AM CEMIAY INSURANCE *%mo Zo Conlert 21M CENTURY MdSURAKE 21SrCFNrURY PWA Flo. Pox 18510 WILME4IQ` (X DE l9M-.' 510 . `... .ln�uIV A, g� Iy 1 6N 0111,11 s100, 0aa a t1 person inOM�t's'0.50 t�Mfa9raud le@ 2goo each aculdont 129.00x ;: 67,00 pag „eUa T e h kdant s 60.0n t 04.00 C. Madleal Pa meats 45, QQQ earn r301 a a A ..a Uninsured O'riat @7:00,000 eachpers n €L Bo91 I u 00 000 each aCCkfent 8 35,00 t 40..00 CAfl(AGE TO YOU Vtl1t VEkf2 3 3 7.Gtl s GO-.QO, Aol G"tV VMW [ka..�m _ ensive �R ACV ,.,,.6120 St Pa Cdllsion Rb 4h. 10tl g190 @ 8A. n �, 1,03.00 �nirwur D1 aao wAtvF„ esn waive eeu w.ziVL G 2.00 G 81at century a ROadsftle Assistance tis aeth dt a6lernant SncSnaed kZwed H. Rra r1.rmwi( .max qjl %kg4 J. 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