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Home My WebLink AboutLE, CHOC 2ACity of Santa "-ia . ' Clerk of the COL, .vll AGREEMENT TERMINATION Please complete this form when the attached agreement is no loagr Imo. fit.fi 9 28 Return form to the Clerk of the Council Office (M-30). Call 647-5237 if you have any questions. The agreement with C No.� ( %l)'U was completed on 30 Q� and final payment has been made: Department: CSP4 G�-C GZ 4) Revised 07-23-07 /f' -o�o-1g5 C200� ✓ Phone/Ext.: Signature: �1 Date: i�- ,�.n LTIRES• N-2001-108 " J AMENDMENT TO AGREEMENT EE1 :C;;r COUKUL TINS' i41WDMMENT, made and entered into this 19s' day of June 2001, by and between Choc Le ("Consultant") and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City"), collectively referred to herein as "the Parties". I ��[MM�I�rld A. The Parties entered into that certain agreement entitled "Consultant Agreement" dated November 30, 2000, hereinafter referred to as "said Agreement", for providing tae kwon do classes at Salgado Center. B. The Parties hereto now desire to amend the Compensation, Term and Scope of Service of said Agreement in order to in order to provide continuous uninterrupted service under the 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 1, of said agreement, pertaining to Scope of Services of said agreement is hereby amended to change class size from 65 to 60. Classes from 9-1 lain (June -December 20001) held in the gym and from 12-1 p.m. in the multipurpose room, from 9 p.m. to 1:00 p.m. classes held in the multipurpose room (Jan -May 2002). No classes held on the following dates: July 4, 2001; September 3, 2001; November 12, 2001; November 22-23, 2001; December 24, 2001- January 4, 2002; January 21, 2002; February 18, 2002; May 27, 2002. 2. Section 2, of said agreement, pertaining to "Compensation" term of said Agreement is hereby amended to reflect an increase in compensation of an amount not to exceed $10,000.00 due to an unexpected increase in the City's need for the Consultant's services under said Agreement. Section 3, of said Agreement, pertaining to Term of said Agreement is hereby amended to change the termination date of June 30, 2001, to June 30 2002, in order to provide necessary continuous uninterrupted service to the Agency. 4. Except as hereinabove modified, the terns 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. AT PATRICIA E. HEALY Clerk of the Council (signatures continued on next page) OF SANTA ANA DAVID N. REAM City Manager ' APPROVED AS TO FO* JOSEPH W.FLETCHER City Attorney � By: UA Michael Vighotta Deputy City Attorney REC MMENDED FOR APPROVAL: C e e Williams Executive Director of the Parks, Recreation and Community Services Agency COr4TRACTOR ka,w Qj--,0C I-P Tax ID# CORD_- CERTIFICATE LIABILITY INSURANC 03OP 50750 R DATE (MM OD/03 57 03 28 03 PRO UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fi ness & Wellness Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ag 38 incy Stevens Ave., First Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So ana Beach CA 92075 Ph one:800-395-8075 Fax:858-519-0822 INSURERS AFFORDING COVERAGE NAIC# INSL RED INSURER A: Specialty National Insurane INSURER B: Choc V. Le #0375057 8ff: 01-06-03 INSURERC: INSURER D: 4 Firiano Irvne CA 92620 INSURER E: CO &RAGES TI IE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AJ Y REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR V PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NIJIJ� SR TYPE OF INSURANCE POLICY NUMBER FULICT EFFECTIVE DATE MMID POLICY EXPIRATION DATE MWD LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A X X COMMERCIAL GENERAL [ABILITY 3XZ126451-02 01/06/03 01/06/04 PREMISES (Ea xarence) $100,000 CLAIMS MADE FX] OCCUR MED EXP (Any we Person) S2,500 PERSONAL SADVINJURY $1,000,000 A X Nisc.Professional GENERAL AGGREGATE S3,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG S1,000,000 POLICYF—j JECT F-ILOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Par accident) S GARAGE LIABILITY AUTO ONLY• EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGO EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/ PARTNERIEXECUTNE WL' TORY LIM5TABS ER E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYE $ OFFICER(MEMBER EXCLUDED? tt yes. AL cribePRO ISIO SPECIAL PROVISIONS below E.L. DISEASE •POLICY LIMIT S - OTHER A Sexual Abuse 3XZ126451-02 100,000 300,000 )ES It RIPTIONOFOPERATIONSILOCATIONSIVEHICLESIEXCLUSIONSADDEDBYENDORSEMENTISPECIALPROVISIONS APPROVED AS ILA FORM is understood and agreed City of Santa Ana, its officers, agents, employees, representatives, and volunteers are added as addition in uered per the attached form CG201011/85 LRL .-,ihcedy I)cpuly City Attorney ;E TIFICATE HOLDER CANCELLATION SANANAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 30 DAYS WRITTEN City of Santa Ana Parka and Recreation, & Community NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Services Agency P.o. Box 1988 N-23 AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 Jeffrev E. Frick 25 (2001I08) 0 ACORD CORPORATION 1988 This Endorsement changes the Commercial Liability Policy. PLEASE read it carefully. This endorsement, effective on 01/06/02 at Standard time shown in the Policy Declarations, forms apart of Policy Number 3XZ126451-01 issued to Choc V. Le #0375057 by Hull & Company (Specialty Nat). Endorsement Number 001 This endorsement modifies insurance provided for under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ADDITIONAL INSURED - BLANKET FORM WHO IS AN INSURED (Section II) is amended to include as an insured the person(s) or organization(s) shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. Name of Person or Organization City of Santa Ana Parks & Recreation Dept PO Box 1988 Santa Ana, CA 92702 All certificates of insurance holders you have agreed to include as an insured prior to an "occurrence" or offense. (8-97) APPROVED AS TO FORM hurt hcedy Dapumy City AtG rney 01/10/03 15:23 Z 004 ADDITIONAL INSURED ENDORSEMENT Insurance Company- 2&t . aN1 IvwU�O'Ylrt This endorsement modifies such insurance as is afforded by the provisions of Policy # '5Xj 17-(p445 I - OZrelating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701: its officers, employees, agents and volunteers are named as additional insureds ("additional insureds') with regard to liability and defense of suits arising from the - - --operations-aad uses perfoaned-hyor 0a behatLof the named iosumd— 2. With respect to claims arising out of the operations and uses perfonned by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company s liirAits 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. 4. With respect to the additional insureds, this insurance shall not be canceled, 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 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective t this endorsement form as a part of Policy# 3X zc�4h►-62 Issued to ru l V . I� Named Insu Countersigned by A orized Representative 'PRObi'li AS TO FORM t its 4---- I)a" ty City Attorney