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Home My WebLink AboutCAMPOS, YESSICA 2ACity of Santa Ana t Clerk of the Council AGREEMENT TERMINATION FORM 2.019 AUG 22 P3 4., 1116 Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. CITY OF SANTA ANA CLERK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with N-2015-175 No. was completed on l ,:�1 and final payment has been made. (List all amendments. Use space below if needed.) Department: PA Phone/Ext.: S IS4 Signature: cd4 )ll; CA&AU-n Date:�p Revised 10-31-12 City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. N-2015-175-001 was completed on (List all amendments. Use space below if needed.) COTC Office Use M9 AlIG 22 I'M 01: t?b OF SANTA ANA RK OF COUNCIL 6- _ iA�i l0 and final payment has been made. n Department: ? o — I's A Phone/Ext.:a5 Signature: 5 l )'oAf Date:r� 1 �� Revised: 10-18-16 Ird:^;1'RANGE OM FILE WOK MAY PRI U11) MAYOR �I ill INSURANCE EXPIRES Miguel A. Pulitlo MAYOR PRO TEM CLERK OF COUNT IL.. Vicente Sarmiento 1)!41 E: 0 2 1 2016 COUNCILMEMBERS Angelica Amezcua P. David Benavitles O: PRCS (/ ) Michele Martinez Roman Reyna Silvia Cuevas Sal Tinalero CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 • P.O. Box 1988 M-23 Santa Ana, California 92702 www.santa-ana.org November 23, 2016 Yessica Campos 7082 Senway Drive, Apt, 5 Westminster, CA 92683 Re: Extension of Recreation Services Agreement Agreement No, N-2015-175 Dear Ms. Campos: N-2015-175-001 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvell CLERK OF THE COUNCIL Maria D. Huizar Pursuant to Section 3 of the above -referenced agreement between you and the City of Santa Ana, the term of such Agreement is hereby extended for an additional one (1) year period, from January 1, 2017 through December 31, 2017. All insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Gerardo Mouet, Executive Director Parks, Recreation, and Connnunity Services Agency < —Z� OF SA ANA David Cavazos City Manager APPROVED AS TO FORM Cl�.- ivv. fi Jo M. Funk Assistant City Attorney ATTEST Maria D. Huizar Clerk of Council SANTA ANA CITY COUNCIL Miguel A. Pulitlo Vlncenle. earmienlo i Michele Martinez I Angelica Amezcus P. David Benavitles Roman Rayne Sal Tinajero Mayor Mayor Pro Tem, Ward 1 Wald Ward 1 Wartl4 I Werd6 i Wertl6 MPulidornsanla ana,ory VSarmlentoCnlsanla-ana.oro I MMartinez(o)sanla-ane om 1 AAmezcuaCrDmael anadm Daenavip S t - RRBVna(la aaol&au,,m, STInalerefimm a- ana.ora Exhibit A SCOPE OF SERVICES-Yessica Campos A. Provider shall conduct Folkl6rico dance classes for children aged 5 & 16yrs. B. Folkl6rico dance classes each will be 1 hour per day, $25/per month • Folkl6rico Advance class is Monday and Wednesday, 1 hour per day • Folkl6rico Beginning class is Thursday, I hour per day C. Classes shall be 2 days & 1 day a week, Jan -Mar, April -June, June -Aug, Sept, Oct, November and December shall be three-week sessions due to the holidays D. Provider shall work with City staff in setting a schedule for classes, including the location, specific days and hours when class will be held and holidays to be observed. E. Provider shall provide materials, supplies, equipment, records and personnel. Provider shall to be responsible for cleanup of the facilities and materials and shall ensure the safety and effectiveness of instruction. F. If Provider allows others to teach his/her class, those teachers must be over 21, must have obtained and maintain an instructor rating, and be covered by Providers' insurance. Provider shall provide City with documentation to verify instructor and insurance requirement CLASS SIZE REGISTRATION A. Each class must have a minimum of 5 paid students and no more than a maximum of 22. B. No registration will be accepted after the second meeting of class. C. In the event the minimum number of enrollees is not realized by the second meeting of the class, the class shall be canceled. Provider will be under no obligation to provide services and the City will have no obligations to pay Provider compensation CLASS FEES A. Each participant shall pay a $25.00 registration fee per session, depending on the class attended. Anticipated revenue from this class is $25,000.00 B. No refunds will be made to participants after the first week of class unless the class is cancelled by the City. C. 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. D. Provider shall receive seventy per cent (70%) of the total fees collected each month. City and Provider agree that City shall retain thirty per cent (30%) of the fees collected as an administration fee. E. Provider agrees that City is entitled to audit Providers' records and classes to insure compliance with this agreement. F. Provider may not waive class participation/registration fees. G. City shall prepare class rosters and provide a copy to Provider. Only registered participants may participate in class. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2016-15 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Set -vices, 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: Yessica Campos TYPE: Dance _ 7082 Senway Drive, Apt. 5 % L 15 —I i DATE(S): 01/07/16—12/31/16 Westminster, CA 92683 LOCATION: Memorial Center and Santa Anita 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. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless amended as described in Special Conditions, INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41020 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2016 EXPIRATION: JANUARY 1, 2017 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2 000,000 Products & Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal & Advertising hrjury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Pal icy do not apply to this Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: Medical Payments (Any One Person) 5.000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased d�7 ❑ $1,000,000/S3,000,000 �\e,�2 V� l ❑ $2,000,000/$2,000,000 ¢e l Damage To Property (If purchased) The limits of insurance apply separately to each event insured by this policy as if a repo policy r has been issued for that even[. OTHER ADDITIONAL INS S Laura Campos CANCELLATION Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy rovisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: January 7. 2016 by Briza Morales