WESTFALL, MATTHEW - 2009 - Laserfiche WebLink

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Checklist For Standard Consultant Agreement **A COMPLETE CHECKLIST INCLUDES ALL INFORMATION CONTAINED ON THIS SHEET AND A COPY OF ALL EXHIBITS** The following items should be provided in requesting preparation of agreements for the City: • AGREEMENT NUMBER A- • PROJECT MANAGER, MAIL STATION and EXT: Donna Schultze, M-23 Ext. 4258 • CITY AGENCY: Parks Recreation & Community Services Agency • COMMENCEMENT DATE OF CONTRACT OR CITY COUNCIL APPROVAL DATE: • NAME & LEGAL CAPACITY OF CONSULTANT: Name of Contracting Party Matthew Westfall Legal Capacity of Contracting Party ® Individual ❑Corporation ❑Non -Profit Public Benefit Corporation ❑ Partnership []Sole Proprietorship ❑Limited Liability Company • SCOPE OF WORK/PROPOSALS: Exhibit A attached • TERM OF AGREEMENT: Provide ending dates or duration of contract from effective date. If renewals are provided for, what are the terms and conditions of the renewals? Please note: In general the City cannot contract for more than a single fiscal year without having, set aside the entire contract amount in the current fiscal year. Term: ❑ End of Fiscal Year (June 30) ❑ End of Calendar Year (December 31) ® Other (please provide) 6/30/10 • INSURANCE: Consultant will be required to carry City's standard insurance requirements and Additional Insured Endorsement (Exhibit B to standard agreement). Will professional errors and omissions coverage be needed? Professional Liability (E&O) Coverage: ®Yes ❑ No • COMPENSATION: Instructor receives 70% of class revenue. • PAYMENT SCHEDULE: Payment by city shall be made within fifteen (15) days after completion of class session. • NOTICES: To what address shall notices be sent to the consultant? Contact Person? FAX number? 1707 S. Orange St. Street Address Santa Ana, CA 92707 City, State, Zip Code (7I4) 334-6390 Phone Number mattwgstfallahotmail.com Email Address • SIGNATORIES: What is the name and title of the individual(s) who will sign on behalf of the Other Parry? If the Other Party is a corporation and the signatory is not a president, vice president or CEO evidence of the signatory's authority must be provided, either in the form of a resolution of the Board of Directors, attested by the corporate secretary, or in the form of a letter signed by the corporation's president, vice president, chief executive officer or corporate secretary. If the Other Party is a partnership, the signature must be a general partner. Name Matthew Westfall Its Instructor (e.g., President, Chief Executive Officer, General Partner, Owner, Executive Director) • SPECIAL PROVISIONS: (ownership of work product, Please state any special provisions you want included in the contract. • DOES CONSULTANT HAVE ANY OTHER OPEN AGREEMENTS WITH THE CITY? If so, please list each contract and the amount: • ADDITIONAL REMARKS: