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Home My WebLink AboutRIVERA, SALOMON 1ac 200bJ AGREEMENT TERMINATION X89111 tVIN 16 P e[ 1E: 22 Please complete this form when the attached agreement is no longer in effect. it�a9- � " L E,r, Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647- H§Ilf yb hay t' =y' questions. The agreement with CL, �x c ova No. 0 - DD04- 433 -o 1 was completed on and final payment has been made. tJ ' 200y • d3� Department: or Signature: Date: � PI IL City of Santa Ana Revised 8 -7 -03 Clerk of the Council INSURANCE ON HLt WORK MY PROCEED UNTIL INSURANCE EXPIRES iz -3 I -O4 CLERK OF COUNCII DATE iJ —y0 -04 FIRST AMENDMENT TO C P CONSULTANT AGREEMENT n1- aoo�- oaa -o! THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into this 30'U- day of _DeCkrAb ev- , 2004, by and between Salomon Rivera ( "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 -033, dated April 27, 2004, (hereinafter "said Agreement ") by which Consultant has provided salsa dance instruction 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: IMOSEPH W.FLETC R City Attorney CITY OF SANTA ANA Executive Direct(* — Parks, Recreation and Community Services Agency EVANSTON INSURANCE COMPANY CERTIFICATE NO.: N -a,90 -l- 03 3 CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM t'f<ODl10ER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver A7liant Ilu'waace Services City of Santa Ana 4.Box2 &323 20 Civic Canter Plaza, M -28 Santa Ana, CA 92799 -8323 P.O. Box 1988 S98`li -81(13 Santa Ana, CA 92702 License No: (]L 36661 ti.yM> D INSURED (EVENT HOLDER): EVENT WPORlvLA WN: S:r.e.r,Ir,esl. ii's.va�.n.FL TYPE: 709 S. Parton StAeet _'Dance DATE(5): 7US- Santa Ana, CA 92701 _ LOCATION- 4Anua t?ruoR .e P.na IL's Is to certify that the policies of bormance listed below have bom raved to the insured named above for the policy period indicated. Notwithstanding any regoirem lds, temp or conditions of ary contract or other dacument with respect to wlnch this certificate nay be issued or may pertain, the insurance afforded by the policies described herein is subject to all the tents, exclusions and conditions of such pohmes. Limits shown may Lave been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPI000OOI MASTER POLICY DATES: EFFEC'T'IVE; JANUARY 1, 2004 EXPIRATION: JANUARY 1, 2005 COMMERCIAL GENERAL LIABILITY Gmcni Appcpple Lirfil. OCCURRFNcf FORM T)Et)11C1'mLfi: NONE i 2 'Mo P'Woci] @ I;;nmpleted th, avilOnY 1030.0w 1> cal 1L Advemama I j�Y I,Wkwo P=h Occtontwc Lin:il 1,addaito fire 6amibt IAnY One Fire! .5oxw 5lniiril Pay,re:nis (:4ny Gnc Persunl 0oaa n.:4 oI` inwmncr a1gkY sellal}iciY tq eat'h tl'CIFI nnutpil b UIIS ^ -- y Polity fi lffa"P&MlPali']. 01 LSfftd l'0f 1fn3 CYeN. \tihG N IOUII W' 1]'�:nC11110110 inelulk, as y Wwmd, dlC pgapt Vf bLyllfliufm $110" is alit w A`dnl5 but only With mpm m lubillty L sjna Out of the )4iW(a Yp, madlttlWlGf! ]Yt LLEk Ot dNe pYlYritY1 of W Lry the iml]ed iTSV1Y�t (evalr M7derl• Tltit rwasliee dou non a Wy lo: Any p1wr 'rl (C! ItK event. hohiY cOYft9 10 � 0 iplani T tltarpmnvs. OTHER ADDITIONAL INSUREDS —' LAtir- .klLUbL.N. 3hMwld the abo t dt ribed policy tr, cancelled Wble na expiration date thereof, The ifauiea cargaey will mail 30days witW notice to the cern8ale holder rid addiwnui lands Us" AUTHORIZED REPRESENTATIVE: DATE ISSUED: 4107104 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: - CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM AUTHORIZED REPRESENTATIVE: DATE ISSUED: Febhualty 23, 2005 PUBLIC ENTITY (ADDITIONAL INSURED) FAIWant Insurance Services C1t y o b Santa Ana 23 20 C.iv.ic Center[. Ptaza, M -28 92799 -8323 Santa Ana, CA 92701 3 cense o: OC 36861 NAMED INSURED (EVENT HOLDER): o4:? Satomon R.iveha EVENT INFORMATI N: TYPE: `nso-tionat -SaCaa Dancing 709 S. Pahton Street /�` °( DATE(S): 2/23 Santa. Ana, CA 92701 LOCATION: SOut lulebt Sen:iae Center 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 terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 05SEP1000001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY 1, 2006 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit S 2,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 110001o00 Each Occurrence Limit 11000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 51000 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. "Who is insured" is amended to include, as an insured, the palm 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 premises. OTHER ADDITIONAL INSUREDS APPROVED AS TO FOR,,. t hee Assistant City Attorn-- CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: Febhualty 23, 2005 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) City of Santa Ana Driver Alliant Insurance Services in conjunction with 20 Civic Center Plaza, M -28 Apex Insurance Services Santa Ana, CA 92701 P. O. Box 28323 Santa Ana, CA 92799 -8323 (949) 660 -8163 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Salomon Rivera A) ..33 TYPE: Salsa Classes 709 S. Parton Street DATES O January 1 - December 31, 2006 Santa Ana, CA 92701 LOCATION: Southwest Senior Center N— �CO�l— c33 —c.,Z 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 terms, exclusions and conditions of such policies. Limits shown may have been reduced by paid claims. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 04SEPI00o001 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2006 EXPIRATION: JANUARY 1, 2007 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit 52,000,000 Products & Completed Operations 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence Limit 1,000,000 Fire Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 The limits or insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. "Who is insured" is amended to include, 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 premises. OTHER ADDITIONAL INSUREDS CANCELLATION Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: DATE ISSUED: Ltsl1