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HomeMy WebLinkAboutDELHI CENTER - 2003 FEZ 1ST AMENDC 2.005- AGREEMENT .005 AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions. ------------------------------------------------------------------ The agreement with 4&- - e2X� 4 No.7 � Z was completed on Y(.s� bru �-VV Ir h "-2003-,bo cpm Department Signature: Date: Revised 8-7-03 City of Santa Ana Clerk of the Council INSURANCE ON FILE WORK MAY PROCEED A-2004-060 UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATEa (p—,2 -0'I FIRST AMENDMENT TO AGREEMENT Gi Ce/4 THIS FIRST AMENDMENT TO AGREEMENT is entered into on April 5, 2004, by and between Delhi Center ("Consultant") and the City of Santa Ana ("City"). Recitals: A. The parties entered into Agreement A-2003-160, dated July 21, 2003, (hereinafter "said Agreement") by which Consultant has provided vocational/occupational training, employment strategies, education and supportive services to individuals residing in the Federal Empowerment Zone. B. In accordance with the terms and conditions of said Agreement, the parties wish to increase the compensation available to Consultant for additional marketing and outreach efforts provided by Consultant. 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 Agreement, the parties agree as follows: Section 2.a., COMPENSATION, shall be amended to increase the compensation by $4,267, for a total amount not to exceed $79,267.00 during the term of said Agreement. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: Y08EPH W.FLETCHE City Attorney CITY OF SANTA A A DAVID N. R AM City Manager CONSULTANT AC12RA CERTIFICATE OF LIABILITY INSURANCE 12/11/200 ) PRODUCER (949) 553-9700 FAX (949) 553-9797 Westland Insurance Brokers 2192 Martin Street, Suite 130 Irvine, CA 92612 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Delhi Commnunity Center i-_1('Oj. IV,O 505 South Central Ave. !1 x`� Y��/+Is Santa Ana, CA 92707-3504 ,;� Jl'h��- INSURERA: TRAVELERS PROPERTY CAS INS CO 36361 INSURER B. Carolina Casualty Insurance Co INSURER C: "REVISED 1/12/04" TO INCLUDE GENERAL LIABILITY INSURERD: DIRECTORS & OFFICERS RENEWAL 12/14/2003 INsuRER E: NO OTHER CHANGES OR ENDTS ATTD EACH OCCURRENCE $ 1,000,000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 660818X4872-03 12/14/2003 12/14/2004 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 PREMISES IF, CLAIMS MADE O OCCUR MED EXP (Any one person) $ S,000 A PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY 8103123W685-03 12/14/2003 12/14/2004 COMBINED SINGLE LIMIT ANY AUTO $ (Ea ecodent) 1,000,000 BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) A BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY. ADS $ EXCESS/UMBRELLA LIABILITY CUP 3289W520-03 12/14/2003 12/14/2004 EACH OCCURRENCE $ 1,000,00 X OCCUR OCLAIMSMADE AGGREGATE $ 1,000,00 A Retained Limit $ 10,00 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TWO STATU- OTH- EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E . DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED'/ if yes, describe under E. L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER Trectors & Officers 3336857-2 01/14/2004 01/14/2005 $1,000,000 Per Claim/Aggregate ggre g ate B $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS he City of Santa Ana is named as Additional Insured as per CN0188(01/96) CGD037(01/99) and Exhibit B attached with respects to the operation of the Named Insured. Except 10 days for Non-payment of Premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)tXX%XXNX MAIL Jeff Stevens, Risk Manager "30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Santa Ana KXd(Nd 4X KXifiO(;Y%hXXd(�X 20 Civic Center Plaza, M28 ➢(i(AN4XdOW(Ai Xi{BfJtYXXXVMXXXDXXXXXXXXXXX Santa Ana, CA 92701 AUTHORIZED REPRES NT TIME , NLVRU 40 jZUU Iwo) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 4IF SUN CERTIFICATE OF LIA131LI f Y MUKANUL izji jzoo3 PRODUCER (949) SS3-9700 FAX (949)553-9797 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Westland Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2192 Martin Street, Suite 130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Irvine, CA 92612 INSURERS AFFORDING COVERAGE NAIC # INSURED Delhi Commnunity Center INSURERA: TRAVELERS PROPERTY CAS INS CO 36361 505 South Central Ave. p`-a�`� ���� INSURERS: Carolina Casualty Insurance Co Santa Ana, CA 92707-3504 INSURER C: INSURER D: INSURER E: CFTVFRAr.FSQ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN$RbD' TP TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONI LIMITS GENERAL LIABILITY 660818X4872-03 12/14/2003 12/14/2004 EACH OCCURRENCE S 1,000,0()1 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR DAMAGE TO RENTED I S LOO , OOI MED EXP (Any one pereon) 3 S,004 PERSONAL & ADV INJURY $ 1,000,001 A GENERAL AGGREGATE 3 21000,004 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOG JECT PRODUCTS - COMPIOP AGG S 2.000,004 AUTOMOBILE LIABILITY ANY AUTO 8103123W685-03 12/14/2003 12/14/2004 COMBINED SINGLE LIMIT (Ea accident) 1,000,00 1,000,001 BODILY INJURY 3 (Per perew) A X X ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) 3 PROPERTY DAMAGE S (Par accldenl) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA AGC $ AUTO ONLY: AGG S A EXCESSIUMBRELLALIABILITY X OCCUR O CLAIMS MADE CUP 328914520-03-T2724/2003 - a; -PIS J . _ _ . 12/14/2004 . , ., :�` > EACH OCCURRENCE 3 1100-0,00( AGGREGATE $ 1,000,00( Retained Limit s 10,00( DEDUCTIBLE 4 RETENTION S 3 WORKERS COMPFNSA71ON AND EMPLOYERW LIABILnY ANY PRppRIETOR/PARTNER/EXECInNE`!�' OFFICERIM EMBER EXCLUUED7 If yes, deatribe under i -,� LI y - - 1^rC STATU- QTH- E.L. EACH ACCIDENT S E.L. DISEASE • EA EMPLOYEq 3 EL DISEASE -POLICY LIM IT 1 3 SPECIAL FROM SIONS below B °TfEII3336857 -hectors & Officers 01/14/2003 01/14/2004 ;1,000,000 Per Claim/Aggregate $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Y16- a Hnlifv Ri.A. Tn Allnnneulonn I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECU%PROVISIONS I,, 11,n_1 Santa Ana Empowerment Corporation and the City of Santa Ana are named as Additional Insured's per attached GN0188 (0196) and CGD037 (0199) non-payment of premium which is a 10 day notice of cancellation Santa Ana Work Center Laura 1000 E. Santa Ana Blvd Suite 200 Santa Ana, CA 92781 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL VIYXXlxiM MAIL n30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, �'��xx�u�cxxaccxa(xlra�€xxxxnla�mlx�L>vx�xxxxx AUTHORIZED ©ACORD CORPORATION 1981 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. '-'P 'r%1tiib1 ciLV ACORD 26 (2001108) POLICY NUMBER: X -660 -818X4872 -TIL -03 COMi.._ACIAL GENERAL LIABILITY ISSUE DATE: 12/14/03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHARITY FIRST -AMENDMENT OF COVERAGE -- WHO IS AN INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization (Additional Insured): THE SANTA ANA EMPOWERMENT COi3PORATION AND THE CITY OF SANTA ANA Designation Of Premises (Part Leased to You) WHO IS AN INSURED (Section II) Is amended to include as an insured: A. Your members and volunteers but only with respect to their liability for your activities or ac- tivities they perform on your behalf; B. Your trustees or members of the board of gover- nors while acting within the scope of their duties as such on your behalf; and C. Person(s) or organization(s), whether or not shown in the Schedule above, but only with respect to their liability arising out of: t. Their financial control over you; 2. Their requirements for certain performance placed upon you, as a non-profit organiza- tion, In consideration for funding or financial contributions you receive from them; 3. The ownership, maintenance or use of that part of a premises leased to you; or 4. "Your work' for that Insured by or for you. As respects Part C.3. above, this insurance does not apply to: (a) Structural alterations, new construction or demolltion operatipns performed by or on behalf of the person(s) or organiza- tion(s); or (h) Any "occurrence" which takes place after you cease to be a tenant In that premises. GN 01 88 01 86 Copyright, Travelers Indemnity Company. Page t of 1 0033"4 _JMMERCIAL GENERAL, LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS Paragraph 4.b. of CONDITIONS (SECTION IV) is amended as follows: b. Excess Insurance This insurance is excess over any of the other in- surance; whether primary, excess, contingent or on any other basis: (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk, or similar coverage for "your work", (2) That is Fire Insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) If the loss arises out of the maintenance or use of aircraft, "autos", or watercraft to the extent not subject to Exclusion g. of Cover- age A (Section 1); or (4) That is valid and collectible insurance avail- able to you if you are added as an additional insured under any other policy. When this insurance is excess, we will have no duty under Coverage A or B to defend the in- sured against any "suit° if any other insurer has a duty to defend the insured agaipst that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insur- ance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insur- ance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Ex- cess Insurance provision and was not bought specifically to apply in excess of the Limits of In- surance shown in the Declarations of this Cover- age Part. CG 00 37 01 99 Copyright, The Travelers Indemnity Company, 1999 Page 1 of 1 Jan 14 04 07r SOa rJelnl l.en Ler' nume,, .1�.+. .1-- ---- Use 18 03 05:22P Delhi Center Human Reaour 1714)481-9688 Fn -r : C :TM of SWTP " CDR FAX NM :714 647-6736 Hen 18 2083 18:4Wk ADOMONALINSURED BNDORBEM6Ni FOR p WhffRC1AL QMERAL E46P L(TSCEMY jnmaatlm CcnqAW Travelers Property b Casualty 1119 Co 'this eudow wet modifies such inumvece as is 45wde4 by 41e provisions of Policy * 66081814872-03 Iciatfttothe following: 1. 7"he City a Sanbt Asa, 20 Civic C=M Plaza, Santo Asa, California 92701; it; ogNxw , wnployew, scrota, vohatem and reprowniatlws am named as P t6itionai inKmmb ("additiaWp metweds' with Rlrnd to liability and definee of oft arising Som the operstioss and uses patmum d by ar on bsbslfof the nested insured. 2- WYh rapaoc to claims arising out of dor opeookm and uses performed by or on behtif of the wwad hutaad. such irlsrowwo as is affirded by this policy is primary ead is not edditiono to or eont ibat* with any other ias=ow caried by or for do benefit of dte ad dew irrwneds, 3. 'lids bmwa ce spplies wpan teiy to each insured na tint Mm dalm Is made ar suit is braugbt except witlt respoet b Yre company's limps of Wbility. 7lw iaoitabn of a;y pawn or o j*aadw as so WRood shall oct mffeet ems right which suc4 pcason of agdtmmOM would have as a c1simaat if not so included. 4. WM reapeot to the additional hunteds„ this :.,.„...,,.. s6li nd be caaoclkd, or maWW[y reduced in covssage a limits wwapt altar thirty (30) days writscn notice has bun given to dw Gert ofthe Cowell, City of Sao Am, 20 Civic Comet Placa, Santee Acs, CmHfbmr 92701. (Cosapletiou of the foi1owi4& iodtldiug vvmtttxsiglaatrs, is reggiW to Wako titin Ondareemcrtt eff=dM) F,ffectivc 1211.4/03 , this endon mmt ibon as spam of Foitcy # e 4 biaaad to Delhi Community Censer Named marred p.2 P4 C.otlabastSAddby AUSaw- d FreWNWOW \1 1 >1.0 d �L_. I _ L:nir:a Slit: ; [c.:cil✓