HomeMy WebLinkAboutSANCHEZ, NORA - 2017 City of Santa Ana
Clerk of the Council COTC Office Use Only
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect. ?al()I AUG 7 I PO f}. r
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form. CITY OF S A N f A AN A
Is the agreement(s)a permanent record?Yes No
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 NCrCa Say- cki 7
No. A-2On— H° was completed on ia,ID /97and final payment has been made.
(List all amendments. Use space below if needed.)
Department: � C
Phone/Ext.: l i q
Signature: Aka/
Date: 3II"I aelq
Revised:10-18-16
A-2017-149
FIRST AMENDMENT TO RECREATION SERVICES
AGREEMENT WITH NORA SANCHEZ
THIS FIRST AMENDMENT to the above -referenced agreement is entered into on June 20,
2017, by and between Nora Sanchez ("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 ("City").
RECITALS
A. The parties entered into Agreement #N-2016-189, dated November 23, 2016 ("said
Agreement"), by which Provider agreed to provide "Tiny Tots" classes in its leisure class
program.
. Per the compensation clause in said Agreement, the City agreed to pay the Provider eighty
percent (80%) of all gross revenue received from program participants. Total revenue to
Provider was not to exceed $25,000.00 annually.
LUc4uU.s .The parties wish to amend said Agreement to include additional funds due to an increase in
aQ i SS registration for classes offered by the Provider during the current term of said Agreement,
wP �, which will expire on December 31, 2017.
WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to
all the terms and conditions of said Agreement, except those amended in this First
Amendment to said Agreement, the parties agree as follows:
Section 3, "Compensation", is hereby amended to include an additional $5,000 for services
to be performed by the Provider. The total sum of the revenue to Provider shall not
exceed $30,000 during the term of said Agreement.
2. Except as modified by this First Amendment, all terms and conditions of said Agreement
shall remain in full force and effect.
{Signatures on Following Page}
Signature Page -- First Amendment
Recreation Services Agreement with Nora Sanchez
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the
Agreement on the date and year first written above.
ATTEST
MARIA D. HUIZAR
Clerk of the Council
I\7JZ�F/�7F�d`�73�77iG1
SONIA R. CARVALHO
City Attorney
By:
LISA STORCK
Assistant City Attorney
RECOMMENDED FOR APPROVAL
CITY OF SANTA ANA
GERARD0 MOUE . .
Executive Director,
Parks, Recreation and Community Services Agency
Page 2 of 2
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2017- 30
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:
Nora Sanchez
TYPE: Preschool/Daycare
12061 Janette Lane
DATE(S): 01/30/17 —12/31/17
Garden Grove, CA 92840
LOCATION: EI Salvador Center
*Liquor Liability Yes ❑ No N
**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: SEP41023
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018
COMMERCIAL, GENERAL LIABILITY
OCCURRENCE FORM
DEDUCTIBLE: NONE
General Aggregate Limit $ 2,000,000
Products & Completed Operations 1,000,000
SPECIAL CONDITIONS:
Personal & Advertising Injury 1,000,000
The following endorsements attached to
Each Occurrence Limit 1,000,000
the Master Policy 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
❑ $1,000,000/$3,000,000
7 $2,000,000/$2,000,000
Damage To Property (If purchased)
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.
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:
WORKERS' COMI'ENSAT[ON DECLARATION
1 hereby affirm under penalty of perjury, the
(NamcfTitle
following declaration
I certify on behalf of 001lh SA�.gp— that during the term of my
(Consultant`Compaay Name)
contract for services with the City of Santa Ana, I will
not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions and provide proof of workers' compensation coverage.
DATE: M- €3 —16
By:
Na
Titl
me:
e: mwd6y
Telephone: � `i• .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), N
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR
N SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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