HomeMy WebLinkAboutPatrick, Margaret 1aC' 2 @o J
AGREEMENT TERMINATION
21116 JUM [ 6 PH 4: 21
Please complete this form when the attached agreement is no longer in effect,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). Ca11647 -52$ if,wav�r { ;;5
questions.
The agreement with ��: -ee k MQYCtAV e No. AJ- a00- 047-01
was completed ont ' and final payment has been made.
N-2004-Oy� Department: me V'A- (0 „,
Signature: �. XJ"�18
Date: (p j k)) )4+
City of Santa Ana
Revised 8 -7 -03 Clerk of the Council
iNSURANCE ON FILL
!",CORK MAY PROCEED
UNTIL INSURANCE EXPIRES
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CLERK OF COUNCIL
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N - 01/ 7 -01
FIRST AMENDMENT TO
CONSULTANT AGREEMENT
THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into
this 30'4` day of AeCRxvJkv , 2004, by and between Margaret Patrick
( "Consultant ") and the City of Santa Ana, a charter city and municipal corporation of the
State of California ( "City ").
Recitals:
A. The parties entered into Agreement N- 2004 -047, dated May 6, 2004, (hereinafter
"said Agreement ") by which Consultant has provided belly dance classes through the
City's leisure class program.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
renew said Agreement for an additional one -year period.
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 Consultant Agreement, the parties agree as follows:
1. Section 3, TERM shall be amended to extend the term through December 31, 2005.
2. Except as hereinabove amended, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to
Consultant Agreement on the date and year first written above.
APPROVED AS TO FORM:
4-JO EP W. FLETCHE
City Attorney
CITY OF SANTA ANA
I I I wo-B L
Executive Director — Parks, Recreation and
Community Services Agency
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.:
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER:
Driver Alliant Insurance Services City o6 Santa Ana
P. O. Box 28323 20 Civic CenteA Peaza, M -28
Santa Ana, CA 92799 -8323 Santa Ana, CA 92701
(949) 660 -8163
License No: OC 36861
Makgahet Patorick TYPE: 7"tnuctionat - Dance
102 S. Glendon StAeet DATE(S): 6103104 - 12131104
Anaheim, CA 92806 /1/— eZDO� —D'�7 LOCATION: Sout at Seniors CenteA
This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period
indicated. Notwithstanding any requirements, terms or conditions 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 terns,
exclusions and conditions of such policies. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 04SEP1000001
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005
COMMERCIAL GENERAL LIABILITY
OCCURRENCE FORM DEDUCTIBLE: NONE
General Aggregate Limit
$2,000,000
Products& Completed Operations
1,000000
Personal & Advertising Injury
1,000 000
Each Occurrence Limit
1,000000
Fire Damage (Any One Fire)
50,000
Medical Payments (Any One person)
5,000
1 The limits of insurance apply separately to each event insured by this Policy M if 2 separate policy of insurance has been issued for that event.
who is insured' is amended to mclude, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the
ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any -occurrence, which takes place
after the event holder ceases to be a tenant in that oremises.
ADDITIONAL
CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will nail 30 days written notice to the
certificate holder and additional insureds listed.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: 5118104